The relationship between cerebral oxygen saturation changes and post operative neurologic complications in patients undergoing cardiac surgery (original) (raw)
Related papers
Objective: To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Methodology: Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB (on -pump) Group II: without CPB (off-pump) Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE). Cerebral oxygen saturation was also measured. Results: There was no statistical difference in desaturation of more than 20% among three groups (P=0.113) but it was significant between group I and II (P=0.042). Changes of rSO 2 in different hours of surgery was significant in group I and group II (P=0.0001 in both ) but it was not significant in group III ( P=0.075) . Conclusion: Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications.
Journal of Cardiothoracic and Vascular Anesthesia, 2004
To evaluate the relationship between cerebral oxygen saturation and neuropsychological dysfunction after cardiac surgery. Design: Prospective and observational study. Setting: Operating room and cardiac floor of a university hospital. Participants: One hundred one patients undergoing elective cardiac surgery with cardiopulmonary bypass Intervention: Bilateral noninvasive cerebral oxygen saturations were monitored over the forehead. The anesthetic and surgical techniques were performed as usual, and no interventions were attempted based on the monitor. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE) and the antisaccadic eye movement test (ASEM). Measurements and Main Results: Preoperative baseline values of cerebral oxygen saturation (rSO 2) were 58.6% ؎ 10.2%. Patients with the nadir rSO 2 <35% had significantly higher incidences of postoperative ASEM and MMSE impairments than those with rSO 2 always above 35% (44% and 33% v 12% and 9%, respectively). Patients with areas of rSO 2 <40% for more than 10 minutes • % presented with a significantly higher incidence of postoperative ASEM and MMSE impairments than those with areas of rSO 2 <40% for less than 10 minutes • % (42% and 32% v 13% and 10%, respectively). Patients with postoperative ASEM or MMSE impairment had significantly lower nadir rSO 2 and significantly larger areas of rSO 2 <40%, <45%, and <50% than those with normal postoperative neuropsychological outcome. However, multivariate logistic regression analysis showed that areas of rSO 2 <40% were the only predictor for both postoperative ASEM and MMSE impairments. Conclusions: Intraoperative cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery with cardiopulmonary bypass. However, it remains to be determined whether interventions to maintain adequate cerebral oxygenation may improve neuropsychological outcome.
Journal of Cardiothoracic and Vascular Anesthesia, 2012
Objective: This "real-world" study was designed to assess the patterns of regional cerebral oxygen saturation (rSO 2) change during adult cardiac surgery. A secondary objective was to determine any relation between perioperative rSO 2 (baseline and during surgery) and patient characteristics or intraoperative variables. Design: Prospective, observational, multicenter, nonrandomized clinical study. Setting: Cardiac operating rooms at 3 academic medical centers. Participants: Ninety consecutive adult patients presenting for cardiac surgery with or without cardiopulmonary bypass. Interventions: Patients received standard care at each institution plus bilateral forehead recordings of cerebral oxygen saturation with the 7600 Regional Oximeter System (Nonin Medical, Plymouth, MN). Measurements and Main Results: The average baseline (before induction) rSO 2 was 63.9 ؎ 8.8% (range 41%-95%); preoperative hematocrit correlated with baseline rSO 2 (0.48% increase for each 1% increase in hematocrit, p ؍ 0.008). The average nadir (lowest recorded rSO 2 for any given patient) was 54.9 ؎ 6.6% and was correlated with on-pump surgery, baseline rSO 2 , and height. Baseline rSO 2 was found to be an independent predictor of length of stay (hazard ratio 1.044, confidence interval 1.02-1.07, for each percentage of baseline rSO 2). Conclusions: In cardiac surgical patients, lower baseline rSO 2 value, on-pump surgery, and height were significant predictors of nadir rSO 2 , whereas only baseline rSO 2 was a predictor of postoperative length of stay. These findings support previous research on the predictive value of baseline rSO 2 on length of stay and emphasize the need for further research regarding the clinical relevance of baseline rSO 2 and intraoperative changes.
Interactive Cardiovascular and Thoracic Surgery, 2009
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of cerebral regional oxygen saturation (rSO ) monitoring during cardiac surgery can lead to improved clinical outcomes. Altogether 488 papers 2 were found using the reported search, of which eight presented the best evidence to answer the clinical question. The author, year, journal, country of study, study type, patient group studied, relevant outcomes, results and study weaknesses were tabulated. Four prospective and another four retrospective studies involving adult and paediatric patients undergoing various cardiac surgical procedures were selected. These have demonstrated that prolonged intra-operative cerebral desaturations are associated with adverse neurological outcomes and prolonged hospital stay. Further, interventions carried out by thoughtful use of the cerebral oximeter are associated with significant reduction in neurologic injury, major organ morbidity and mortality (MOMM) and duration of hospital stay. Some studies have indicated decreased ventilation and intensive care unit (ICU) stay times as well. Clinical benefit and the lack of use-associated risk of injury at a modest expense support the use of this device routinely in patients undergoing cardiac surgery.
Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery
Anesthesiology
Background Despite evidence suggesting detrimental effects of perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac surgery. Hyperoxygenation may increase oxidative damage and neuronal injury leading to potential differences in postoperative neurocognition. Therefore, this study tested the primary hypothesis that intraoperative normoxia, as compared to hyperoxia, reduces postoperative cognitive dysfunction in older patients having cardiac surgery. Methods A randomized double-blind trial was conducted in patients aged 65 yr or older having coronary artery bypass graft surgery with cardiopulmonary bypass. A total of 100 patients were randomized to one of two intraoperative oxygen delivery strategies. Normoxic patients (n = 50) received a minimum fraction of inspired oxygen of 0.35 to maintain a Pao2 above 70 mmHg before and after cardiopulmonary bypass and between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients (n = 50) received a fraction of insp...
Preoperative Cerebral Oxygen Saturation and Clinical Outcomes in Cardiac Surgery
Anesthesiology, 2011
The current study was designed to determine the relation between preoperative cerebral oxygen saturation (ScO 2 ), variables of cardiopulmonary function, mortality, and morbidity in a heterogeneous cohort of cardiac surgery patients. Methods: In this study, 1,178 consecutive patients scheduled for on-pump surgery were prospectively studied. Preoperative ScO 2 , demographics, N-terminal pro-B-type natriuretic peptide, high-sensitive troponin T, clinical outcomes, and 30-day and 1-yr mortality were recorded. Results: Median additive EuroSCORE was 5 (range: 0 -19). Thirty-day and 1-yr mortality and major morbidity (at least two major complications and/or a high-dependency unit stay of at least 10 days) were 3.5%, 7.7%, and 13.3%, respectively. Median minimal preoperative oxygen supplemented ScO 2 (ScO 2min-ox ) was 64% (range: 15-92%). ScO 2min-ox was correlated (all: P value Ͻ0.0001) with N-terminal pro-Btype natriuretic peptide (: Ϫ0.35), high-sensitive troponin T (: Ϫ0.28), hematocrit (: 0.34), glomerular filtration rate (: 0.19), EuroSCORE (: 0.20), and left ventricular ejection fraction class (: 0.12). Thirty-day nonsurvivors had a lower ScO 2min-ox than survivors (median 58% [95% CI, 50.7-62%] vs. 64% [95% CI, 64 -65%]; P Ͻ 0.0001). Receiver-operating curve analysis of ScO 2min-ox and 30-day mortality revealed an area-under-the-curve of 0.71 (95% CI, 0.68 -0.73%; P Ͻ 0.0001) in the total cohort and an areaunder-the-curve of 0.77 (95% CI, 0.69 -0.86%; P Ͻ 0.0001) in patients with a EuroSCORE more than 10. Logistic regression based on different EuroSCORE categories (0 -2; 3-5, 6 -10, Ͼ10), ScO 2min-ox , and duration of cardiopulmonary bypass showed that a ScO 2min-ox equal or less than 50% is an independent risk factor for 30-day and 1-yr mortality. Conclusions: Preoperative ScO 2 levels are reflective of the severity of cardiopulmonary dysfunction, associated with shortand long-term mortality and morbidity, and may add to preoperative risk stratification in patients undergoing cardiac surgery.
Anesthesiology, 2016
Background Cerebral oxygen desaturation during cardiac surgery has been associated with adverse perioperative outcomes. Before a large multicenter randomized controlled trial (RCT) on the impact of preventing desaturations on perioperative outcomes, the authors undertook a randomized prospective, parallel-arm, multicenter feasibility RCT to determine whether an intervention algorithm could prevent desaturations. Methods Eight Canadian sites randomized 201 patients between April 2012 and October 2013. The primary outcome was the success rate of reversing cerebral desaturations below 10% relative to baseline in the intervention group. Anesthesiologists were blinded to the cerebral saturation values in the control group. Intensive care unit personnel were blinded to cerebral saturation values for both groups. Secondary outcomes included the area under the curve of cerebral desaturation load, enrolment rates, and a 30-day follow-up for adverse events. Results Cerebral desaturations occu...
Journal of Cardiothoracic and Vascular Anesthesia, 2011
Objective: To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Methodology: Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB (on-pump) Group II: without CPB (off-pump) Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination (MMSE). Cerebral oxygen saturation was also measured. Results: There was no statistical difference in desaturation of more than 20% among three groups (P=0.113) but it was significant between group I and II (P=0.042). Changes of rSO 2 in different hours of surgery was significant in group I and group II (P=0.0001 in both) but it was not significant in group III (P=0.075). Conclusion: Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications.
Cerebral oxygen saturation monitoring in on-pump cardiac surgery - A 1 year experience
2009
To determine the usefulness of cerebral oxygen saturation monitoring in a heterogeneous population of patients undergoing on-pump cardiac surgery and the relationship between minimal perioperative cerebral oxygen saturation (rSO2) levels and clinically relevant outcome parameters. Setting: Cardiac anesthesia unit of a University Hospital Design: Retrospective analysis Participants: n=274 patients monitored bi-hemispherically with an INVOS 5100 cerebral oxymeter and n=526 matched patients without cerebral oxygenation monitoring. The decision to monitor a patient was based on individual co-morbidities associated with an increased risk of stroke (cerebral and/or peripheral artery disease, history of stroke) at the discretion of the attending anesthetist. Interventions: None prespecified. Measurements and main results: In a first analysis, all patients that had been monitored by cerebral oximetry in 2006 were determined by analysis of the anesthesia charts and the institutional cardiac surgery database and compared with a control group matched for Euroscore, age, and type of surgery. This analysis revealed that monitored patients had more preoperative risk factors, had a longer duration of surgery, cardiopulmonary bypass and aortic crossclamp, and needed longer high dependency unit care (all p<0.05) than the control patients. However, major postoperative complications were not different between both groups. In a second analytical step, monitored patients showing intraoperative minimal rSO2 levels of less than 50% or rSO2 levels greater than 50% were compared. This analysis revealed a higher incidence of postoperative organ dysfunction and hospital length of stay in patients with low rSO2 levels. However, groups were not comparable with respect to the preoperative risk profile. To adjust for these differences, in a third analytical step, patients were stratified according to the median Euroscore. This analysis revealed, that patients with an Euroscore ≤ 8 and intraoperative rSO2 levels <50% had more postoperative organ complications and longer high dependency unit and hospital stay in comparison to patients not showing intraoperative cerebral hypoperfusion. Such effects were not detectable in patients with a Euroscore > 8. Conclusions: These data suggests that patients with a higher risk profile for cerebral vascular accidents and renal dysfunction undergoing on-pump cardiac surgery may benefit from cerebral oxygenation monitoring and that rSO2 levels < 50% are associated with an unfavourable clinical course. However, the association between low cerebral oxygen saturation and worse outcome seems to be limited to patients with a low to moderate risk profile (Euroscore ≤ 8).
Annals of Thoracic Surgery, 2009
Background. Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSO 2 ) saturation. The purpose of this study is to examine whether decreased rSO 2 predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG).