Evaluation of Cerebral Oxygenation and Tissue Perfusion in Patients Ongoing Coronary Artery Surgery with Cardiopulmonary By-pass (original) (raw)
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Cardiopulmonary bypass: Perioperative cerebral blood flow and postoperative cognitive deficit
The Annals of Thoracic Surgery, 1995
Increased cerebral blood flow occurring during cardiopulmonary bypass as a result of changes in arterial carbon dioxide tension during acid-base regulation is thought to increase postoperative cognitive dysfunction. We studied 70 patients undergoing coronary artery bypass procedures who were randomized to two different acid-base protocols: pH-stat or alpha-stat regulation. Cerebral blood flow, cerebral blood flow velocity, and cerebral oxygen metabolism were measured before bypass, during bypass (hypothermic [28°C] and normothermic phases), and after bypass. Detailed cognitive tests were conducted before operation and 6 weeks after operation. During 28°C bypass, cerebral blood flow was significantly (p < 0.05) higher in the pH-stat group than in the alpha-stat group (41 ± 2 versus 24 ± 2 mL-100 g-1. min-X), and cerebral blood flow velocity was signif-icantly increased in the pH-stat group and significantly decreased in the alpha-stat group (152% _+ 10% versus 78% --7%). Cerebral extraction ratio of oxygen demonstrated a relatively greater disruption of autoregulation in the pH-stat group than in the alpha-stat group with relative hyperemia of 0.12 + 0.02 versus 0.26 + 0.03, respectively, during 28°C bypass. Using the criterion of deterioration in three or more neuropsychologic tests, a significantly higher proportion of patients in the pH-stat group fared less well than in the alpha-stat group (49% _ 17% versus 20% ± 13%). Patients in the alpha-stat group experienced less disruption of cerebral autoregulation during bypothermic cardiopulmonary bypass, and this was accompanied by a reduction in postoperative cognitive dysfunction.
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...
Pakistan Journal of Medical Sciences Online
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 rSO2 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.
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.
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Patients undergoing cardiac surgery procedures are thought to be at risk of early neuropsychological deficits and delirium. Regional cerebral hypoperfusion may play a role in the etiology of this complication. We hypothesized that low systemic perfusion pressure during cardiopulmonary bypass (CPB) would correlate with early postoperative cognitive dysfunction in on-pump patients. Methods: In this prospective, randomized, single-center trial, we assigned 92 patients scheduled for elective or urgent coronary artery bypass grafting (CABG) to high-pressure (HP: 80-90 mmHg, n = 44) or low-pressure (LP: 60-70 mmHg, n = 48) perfusion groups during CPB. Patients with prior cerebrovascular or psychiatric disorders were excluded. Primary end point was the cognitive outcome as measured by Mini-Mental-Status examination before and 48 h after surgery. Results: Patients' pre-and intra-operative characteristics did not differ between groups. Significantly more patients in the LP group developed postoperative delirium than in the HP group (LP 13%. vs HP 0%, p = 0.017). The postoperative drop in Mini-Mental-Status scores was significantly greater in the LP group (LP 3.9 AE 6.5 vs HP 1.1 AE 1.9; p = 0.012). No group differences were detected in cerebral oxygenation measured by near-infrared spectroscopy during CPB. The LP group's postoperative arterial lactate concentration in the intensive care unit was significantly higher as compared with the HP group (LP 2.0 AE 1.1 mmol l À1 vs HP 1.4 AE 0.6 mmol l À1 ; p < 0.001). We observed no differences between the groups in any other postoperative clinical, functional, or laboratory parameters. Conclusion: Maintaining perfusion pressure at physiologic levels during normothermic CPB (80-90 mmHg) is associated with less early postoperative cognitive dysfunction and delirium. This perfusion strategy neither increases morbidity, nor does it impair organ function.
British Journal of Anaesthesia, 1999
We studied 15 patients undergoing cardiac surgery involving hypothermic cardiopulmonary bypass (CPB). Cerebral arteriovenous difference in oxygen content (AVDO2) was significantly less during CPB and for up to 18 h after operation compared with pre-CPB values (P<0.05). There were no significant changes in mean jugular bulb oxyhaemoglobin saturation (Sjvo 2 ), cerebral arteriovenous difference in lactate content or lactate-oxygen index (LOI). SJVQ 2 and arterial carbon dioxide tension (Paco 2 ) (P=0.005) were positively correlated as were AVDO2 and haemoglobin concentration (P=O.OI2). AVDO2 and Paco 2 (P-0.007) were negatively correlated as were LOI and arterial oxyhaemoglobin saturation (P=0.037). There were no significant correlations between mean arterial pressure and any of the variables. SJVQ 2 and AVDO2 may require correction for changes in Paco 2 ar| d haemoglobin concentration before relating these variables to cerebral outcome.
The effect of coronary artery bypass surgery on brain perfusion
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1998
Coronary artery bypass grafting (CABG) is one of the major treatment methods of coronary artery disease. CABG is an open-heart surgery that uses cardiopulmonary bypass (CPB). After CPB, it is well known that neurological and neuropsychological complications may occur. The purpose of this study was to evaluate brain perfusion patterns before and after CPB and to locate brain perfusion changes in patients with neurological and neuropsycological complications after CPB. Twenty-five patients who underwent open-heart surgery (22 CABG, 3 valve replacement) and 5 patients (4 cholecystectomy, 1 periferic vascular surgery) as a control group were included in the study. The 99mTc-HMPAO injected dose was 925 MBq. Brain perfusion SPECT images were obtained 30-60 min postinjection using a dedicated triple-head brain SPECT camera. Imaging was performed 1 wk before and 4-6 wk after surgery. Technetium-99m-HMPAO brain SPECT slices were evaluated visually and semiquantitatively. None of the patients...
Cerebral oxygenation during cardiopulmonary bypass
Archives of Disease in Childhood, 1998
Cerebral fractional oxygen extraction (FOE) was monitored in 30 children, using near infrared spectroscopy during cardiopulmonary bypass, to investigate the eVect of hypothermia and circulatory arrest. One group of children (n = 15) underwent profound hypothermia with total circulatory arrest (n = 8) or continuous flow (n = 7). Another group (n = 15), of whom only one had circulatory arrest, underwent mild (n = 6) or moderate (n = 9) hypothermia.
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.