Warming during cardiopulmonary bypass is associated with jugular bulb desaturation.
ABSTRACT The objective of this study was to characterize cerebral venous effluent during normothermic nonpulsatile cardiopulmonary bypass. Thirty-one (23%) of 133 patients met desaturation criteria (defined as jugular bulb venous oxygen saturation less than or equal to 50% or jugular bulb venous oxygen tension less than or equal to 25 mm Hg) during normothermic cardiopulmonary bypass (after hypothermic cardiopulmonary bypass at 27 degrees to 28 degrees C). Cerebral blood flow, calculated using xenon 133 clearance methodology, was significantly (p less than 0.005) higher in the saturated group (33.7 +/- 10.3 mL.100 g-1.min-1) than in the desaturated group (26.2 +/- 6.9 mL.100 g-1.min-1), whereas the cerebral metabolic rate for oxygen was significantly lower (p less than 0.005) in the saturated group (1.28 +/- 0.39 mL.100 g-.min-1) than in the desaturated group (1.52 +/- 0.36 mL.100 g-1.min-1) at normothermia. The arteriovenous oxygen difference at normothermia was lower in the saturated group (3.92 +/- 1.12 mL/dL) than in the desaturated group (5.97 +/- 1.05 mL/dL). Neuropsychological testing was performed in 74 of the 133 patients preoperatively and on day 7 postoperatively. There was a general decline in mean scores of all tests postoperatively in both groups with no significant difference between the groups. We conclude that cerebral venous desaturation represents a global imbalance in cerebral oxygen supply-demand that occurs during normothermic cardiopulmonary bypass and may represent transient cerebral ischemia. These episodes, however, are not associated with impared neuropsychological test performance as compared with the performance of patients with no evidence of desaturation.
SourceAvailable from: Mohamed Shaaban Ali[Show abstract] [Hide abstract]
ABSTRACT: Background: A debate has appeared in the recent literature about the optimum rewarming strategy (slow vs. rapid) for the best brain function. This study was designed to compare the effect of slow versus rapid rewarming on jugular bulb oxygen saturation (SjO2) in adult patients undergoing open heart surgery. Materials and Methods: A total of 80 patients undergoing valve and adult congenital heart surgery were randomly allocated equally to rapid rewarming group 0.5 (0.136)°C/min and slow rewarming group 0.219 (0.055)°C/min in jugular bulb sampling was taken before, during and after surgery. Surgery was done at cardiopulmonary bypass (CPB) temperature of 28-30°C and rewarming was performed at the end of the surgical procedure. Results: CPB time, rewarming period were signiﬁ cantly longer in the slow rewarming group. Signiﬁ cant difference was observed in the number of the desaturated patients (SjO2 ≤ 50%) between the two groups; 14 (35%) in rapid rewarming versus 6 (15%) in the slow rewarming group; P = 0.035 by Fisher’s exact test. Conclusions: Slow rewarming could reduce the incidence of SjO2 desaturation during rewarming in adult patients undergoing open heart surgery.04/2014; 8(2). DOI:10.4103/1658-354X.130698
[Show abstract] [Hide abstract]
ABSTRACT: Background and objective Imbalance between cerebral oxygen supply and demand is thought to play an important role in the development of cerebral injury during cardiac surgery with cardiopulmonary bypass.Methods We studied jugular bulb oxygen saturation, jugular bulb oxygen tension, arterial–jugular bulb oxygen content difference and oxygen extraction ratio in 20 patients undergoing warm coronary artery bypass surgery (34–37°C) with pH-stat blood gas management.Results Only two patients showed desaturation (jugular bulb oxygen saturationEuropean Journal of Anaesthesiology 02/2001; 18(2):93-99. DOI:10.1097/00003643-200102000-00006 · 3.01 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Monitoring of the jugular oxygen venous saturation (SjO2) is mainly founded on the metabolic autoregulation of the cerebral blood flow (CBF). When the cerebral demand in oxygen changes, this mechanism induces a proportionnal adaptation of the CBF. Thus, SjO2 measurement allows a continuous monitoring of the cerebral blood flow — cerebral metabolic rate of O2 relationship. In normal conditions, SjO2 fluctuates between 55 and 75 %. When SjO2 increases > 75 %, hyperemia is present, i.e. CBF and cerebral O2 delivery exceed the cerebral demand of O2. When SjO2 is below 55 %, there is a state of oligemia, which implicates that CBF and cerebral O2 are insufficient to meet the metabolic demand. In such situation, cerebral ischemia is likely. In clinical conditions, there are several studies suggesting that SjO2 monitoring is a useful tool in intensive management of severely head injured patients. It gives useful informations for the therapeutic use of hyperventilation, mannitol and barbiturates. The clinical application of SjO2 monitoring in cardiac anethesia is currently under evaluation.Réanimation Urgences 01/1996; 5(4). DOI:10.1016/S1164-6756(96)80120-4