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Ann Thorac Surg 1992;53:827-832
© 1992 The Society of Thoracic Surgeons

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Articles

Warming during cardiopulmonary bypass is associated with jugular bulb desaturation

Division of Cardiac Anesthesia, Departments of Anesthesiology and Psychiatry, the Heart Center of Duke University Hospital, Durham, North Carolina USA

Accepted for publication October 14, 1991.

^_* Address reprint requests to Dr Reves, Box 3094, Duke University Medical Center, Durham, NC 27710.

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 50% or jugular bulb venous oxygen tension 25 mm Hg) during normothermic cardiopulmonary bypass (after hypothermic cardiopulmonary bypass at 27 ° to 28 °C). Cerebral blood flow, calculated using xenon 133 clearance methodology, was significantly (p < 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 < 0.005) in the saturated group (1.28 ± 0.39 mL · 100 g^–1 · 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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