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Cerebral oxygenation is better during mild hypothermic than normothermic cardiopulmonary bypass
1Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center, Japan.
Insights
Mild hypothermic cardiopulmonary bypass (CPB) better maintains cerebral oxygenation during coronary artery bypass graft (CABG) surgery compared to normothermic CPB. Jugular oxygen saturation (SjvO2) remained stable with hypothermia but decreased with normothermia.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Physiology
Background:
- Normothermic cardiopulmonary bypass (CPB) is increasingly used in cardiac surgery.
- A controversy exists regarding neurological disorder incidence after coronary artery bypass graft (CABG) surgery between normothermic and mild hypothermic CPB.
- Cerebral oxygenation monitoring is crucial during CPB.
Purpose of the Study:
- To assess the effects of normothermia versus mild hypothermia (32°C) during CPB on jugular oxygen saturation (SjvO2).
- To compare cerebral oxygenation between normothermic and mild hypothermic CPB during CABG surgery.
Main Methods:
- Twenty patients undergoing elective CABG were divided into two groups: normothermic CPB (n=10) and mild hypothermic CPB (n=10).
- Jugular oxygen saturation (SjvO2) was continuously monitored using a fiber optic oximetry catheter.
- Alpha-stat blood gas regulation was applied throughout the procedure.
Main Results:
- SjvO2 decreased significantly in the normothermic group at 20 and 40 minutes after CPB onset (41.5±2.4% and 43.8±2.8%, respectively) compared to baseline (53.9±5.4%).
- No significant changes in SjvO2 were observed in the mild hypothermic group during CPB.
- No significant differences in jugular venous-arterial differences of lactate or creatine phosphokinase isoenzyme BB were noted between the groups.
Conclusions:
- Mild hypothermic CPB (32°C) preserves cerebral oxygenation better than normothermic CPB during CABG surgery.
- SjvO2 is a reliable indicator of cerebral oxygenation during CPB.
- Mild hypothermia may be beneficial in reducing neurological complications after CABG.
Purpose:
Normothermic cardiopulmonary bypass (CPB) has been recently used in cardiac surgery. However, there is a controversy whether there is a difference in incidence of neurological disorder after coronary artery bypass graft (CABG) surgery between normothermic CPB and mild hypothermic CPB. In this study, we assessed the effects of normothermia and mild hypothermia (32 degrees C) during CPB on jugular oxygen saturation (SjvO2).
Methods:
Twenty patients scheduled for elective CABG surgery were divided into two groups. Group 1 (n = 10) underwent normothermic (>35 degrees C) CPB, and Group 2 (n = 10) underwent mild hypothermic (32 degrees C) CPB. Alpha-stat blood gas regulation was applied. After inducing anesthesia, a 4.0 French fibre optic oximetry oxygen saturation catheter was inserted into the right jugular bulb to monitor SjvO2 continuously throughout anesthesia and surgery.
Results:
The SjvO2 in the normothermic group was decreased at 20 (41.5+/-2.4%) and 40 min (43.8+/-2.8%) after the onset of CPB compared with control (53.9+/-5.4%, P<0.05). However, there was no change in SjvO2 in the mild hypothermic group during the study. No changes in jugular venous-arterial differences of lactate or creatine phosphokinase isoenzyme BB were observed in two groups during the study.
Conclusions:
Cerebral oxygenation, as assessed by SjvO2 was increased during mild hypothermic CPB than during normothermic CPB.