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The Annals of Thoracic Surgery, Vol 53, 827-832, Copyright © 1992 by The Society of Thoracic Surgeons
ND Croughwell, P Frasco, JA Blumenthal, BJ Leone, WD White and JG Reves
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 less than or equal to 50% or jugular bulb venous oxygen
tension less than or equal to 25 mm Hg) during normothermic cardiopulmonary
bypass (after hypothermic cardiopulmonary bypass at 27 degrees to 28
degrees C). Cerebral blood flow, calculated using xenon 133 clearance
methodology, was significantly (p less than 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 less than 0.005) in the saturated group (1.28
+/- 0.39 mL.100 g-.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.
ARTICLES
Warming during cardiopulmonary bypass is associated with jugular bulb desaturation
Department of Anesthesiology, Duke University Hospital, Durham, North Carolina.
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