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HEART SURGERY

Decrease in jugular venous oxygen saturation during normothermic cardiopulmonary bypass predicts short-term postoperative neurologic dysfunction in elderly patients

Yuji Kadoi, MD^*,*, Shigeru Saito, MD^*, Fumio Goto, MD^* and Nao Fujita, MD

^* Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, Gunma, Japan
Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center, Saitama, Japan

Manuscript received November 17, 2000; revised manuscript received June 26, 2001, accepted July 16, 2001.

^* Reprint requests and correspondence: Dr. Yuji Kadoi, Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
kadoi{at}med.gunma-u.ac.jp

OBJECTIVES

We sought to examine whether the decrease in jugular venous oxygen saturation (SjvO₂) during cardiopulmonary bypass (CPB) can be used to predict short-term and long-term postoperative cognitive disorders in elderly patients.

BACKGROUND

It has been reported that elderly patients might be more susceptible to hypoperfusion during CPB.

METHODS

One hundred eighty-five patients scheduled for elective coronary artery bypass graft surgery were studied. Group 1 (n = 56) was young (<50 years old), group 2 (n = 67) was middle-aged (50 to 69 years old) and group 3 (n = 62) was elderly (>70 years old). After induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to monitor SjvO₂ continuously. Hemodynamic variables and arterial and jugular venous blood gases were measured at seven time points.

RESULTS

The cerebral desaturation time (duration when SjvO₂ was <50%) and the ratio of the cerebral desaturation time to the total CPB time in group 3 were significantly different from those in groups 1 and 2 (group 1: 20 ± 6 min and 16 ± 5%; group 2: 19 ± 7min and 14 ± 6%; group 3: 34 ± 9min and 24 ± 7%, respectively; p < 0.05). Also, age (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.0 to 1.8, p = 0.02) and desaturation time (OR 1.3, 95% CI 1.0 to 1.4, p = 0.03) were perioperative factors in relation to short-term cognitive impairment. However, age and desaturation time were not perioperative factors in relation to long-term cognitive impairment.

CONCLUSIONS

Reduced SjvO₂ was associated with short-term cognitive dysfunction in elderly patients.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CBF = cerebral blood flow   CMRO2 = cerebral metabolic rate for oxygen   CNS = central nervous system   CPB = cardiopulmonary bypass   IJP = internal jugular (venous) pressure   MAP = mean arterial pressure   PaCO2 = partial arterial pressure of carbon dioxide   SjvO2 = jugular venous oxygen saturation   TT = tympanic (membrane) temperature

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