Article

Warming during cardiopulmonary bypass is associated with jugular bulb desaturation

Department of Anesthesiology, Duke University Hospital, Durham, North Carolina.
The Annals of Thoracic Surgery (Impact Factor: 3.63). 06/1992; 53(5):827-32. DOI: 10.1016/0003-4975(92)91445-F
Source: PubMed

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.

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    • "These periods of desaturation during rapid rewarming could be explained by an imbalance between cerebral oxygen supply and demand.[89] Animal[14] and human[15] studies revealed that SjO2 desaturation during rapid rewarming occurred due to an increase in cerebral metabolic rate that is temporarily unmatched by an increase in cerebral blood flow. "
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    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 significantly longer in the slow rewarming group. Significant 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
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    • "Furthermore, during the rewarming period following CPB, an increased CBF has also been reported in studies using either transcranial Doppler (TCD) sonography [6] [7] or a cerebral blood flow tracer [8] [9]. The observed increase in CBF was not attributed to a luxury cerebral perfusion but to an increased cerebral oxygen consumption [7] [10]. Because modification of cerebral blood flow during the immediate post CPB has not been systematically examined, we designed a prospective observational study to evaluate by repeated TCD, changes in CBF during the first 24 h after elective coronary artery surgery. "
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    ABSTRACT: To provide understanding of influence of cardiopulmonary bypass (CPB) on cerebral blood flow (CBF), we investigated the effect of CPB on patients' cerebral haemodynamic parameters. Twenty-three patients were prospectively enrolled. CBF was estimated by transcranial Doppler (TCD) to measure blood velocity in the middle cerebral artery (MVMCA), preoperatively T(0) and at four postoperative times (T(1), T(2), T(3), T(4)). At times T(2), T(3) and T(4), MVMCA remained at higher levels than T(0) (P < 0.05). In the multivariate analysis PaCO(2) was independently associated to MVMCA at times T(1) and T(2) (P = 0.03, P = 0.01, respectively) and temperature was independently associated with MVMCA at time T(1) (P = 0.02). Thus, the present study showed an increase in CBF after CPB, that was correlated with raised temperature but not with decrease in haematocrit.
    Interactive Cardiovascular and Thoracic Surgery 03/2003; 2(1):46-52. DOI:10.1016/S1569-9293(02)00098-1 · 1.11 Impact Factor
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    • "Furthermore, during the rewarming period following CPB, an increased CBF has also been reported in studies using either transcranial Doppler (TCD) sonography [6] [7] or a cerebral blood flow tracer [8] [9]. The observed increase in CBF was not attributed to a luxury cerebral perfusion but to an increased cerebral oxygen consumption [7] [10]. Because modification of cerebral blood flow during the immediate post CPB has not been systematically examined, we designed a prospective observational study to evaluate by repeated TCD, changes in CBF during the first 24 h after elective coronary artery surgery. "
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    ABSTRACT: To provide understanding of influence of cardiopulmonary bypass (CPB) on cerebral blood flow (CBF), we investigated the effect of CPB on patients' cerebral haemodynamic parameters. Twenty-three patients were prospectively enrolled. CBF was estimated by transcranial Doppler (TCD) to measure blood velocity in the middle cerebral artery (MVMCA), preoperatively (T0) and at four postoperative times (T1, T2 ,T 3 ,T 4). At times T2 ,T 3 and T4, MVMCA remained at higher levels than T0 (P , 0:05). In the multivariate analysis PaCO2 was independently associated to MVMCA at times T1 and T2 (P ¼ 0:03, P ¼ 0:01, respectively) and temperature was independently associated with MVMCA at time T1 (P ¼ 0:02). Thus, the present study showed an increase in CBF after CPB, that was correlated with raised temperature but not with decrease in haematocrit. q 2002 Elsevier Science B.V. All rights reserved.
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