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Cognition after coronary artery surgery is not related to postoperative jugular bulb oxyhemoglobin desaturation
M J Robson1, R P Alston, I J Deary
1Departments of Clinical and Surgical Sciences (Anaesthetics), University of Edinburgh, Scotland, UK. mrobson@ed.ac.uk
Insights
Jugular bulb oxyhemoglobin desaturation (SjO2) during and after coronary artery bypass grafting (CABG) surgery did not impact long-term cognitive function. Preoperative cognitive status was the primary predictor of postoperative cognition in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Critical Care Medicine
Background:
- Coronary artery bypass grafting (CABG) patients often experience jugular bulb oxyhemoglobin desaturation (SjO2 < 50%) postoperatively.
- The impact of this desaturation on long-term cognitive outcomes remains unclear.
Purpose of the Study:
- To investigate the relationship between intraoperative and early postoperative SjO2 and long-term cognitive performance after CABG.
- To identify predictors of cognitive function following CABG surgery.
Main Methods:
- Cognitive tests administered preoperatively and 3 months post-CABG in 102 patients.
- Intraoperative SjO2 measured via blood sampling.
- Postoperative SjO2 monitored using continuous reflectance oximetry.
Main Results:
- No significant correlation found between intraoperative or postoperative SjO2 and cognitive performance.
- Preoperative cognitive performance was the strongest predictor of 3-month cognitive function (r(2) = 0.83, P<0.001).
- Palpable atheroma of the ascending aorta showed a minor but significant association with cognitive decline (r(2) = 0.018, P = 0.001).
Conclusions:
- Jugular bulb oxyhemoglobin desaturation during and after CABG does not appear to influence long-term cognitive performance.
- Preoperative cognitive status is the primary determinant of cognitive function 3 months after CABG.
- Atheroma of the ascending aorta may contribute to cognitive decline post-CABG.
Abstract:
During the early postoperative period after coronary artery bypass grafting (CABG) surgery, many patients experience jugular bulb oxyhemoglobin desaturation (SjO(2) < 50%). We sought to determine whether SjO(2) during cardiopulmonary bypass and the early postoperative period influenced long-term cognitive performance after CABG surgery. One hundred two patients completed a battery of cognitive tests the day before and 3 mo after CABG surgery. A General Cognitive Score was generated from these tests as an overall measure of cognitive function. Intraoperatively, SjO(2) was determined by intermittent blood sampling, and postoperatively, the area under the curve of SjO(2) < 50% and time was calculated from continuous reflectance oximetry. No significant correlations between cognitive performance and either intra- or postoperative SjO(2) were found. Preoperative cognitive performance was the main determinant of cognition at 3 mo (r(2) = 0.83, P<0.001), and palpable atheroma of the ascending aorta made a small, but significant, contribution to a decline in cognition (r(2) = 0.018, P = 0.001).