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The Annals of Thoracic Surgery, Vol 58, 1702-1708, Copyright © 1994 by The Society of Thoracic Surgeons
ND Croughwell, MF Newman, JA Blumenthal, WD White, JB Lewis, PE Frasco, LR Smith, EA Thyrum, BJ Hurwitz and BJ Leone
Inadequate cerebral oxygenation during cardiopulmonary bypass may lead to
postoperative cognitive dysfunction in patients undergoing cardiac
operations. A psychological test battery was administered to 255 patients
before cardiac operation and just before hospital discharge. Postoperative
impairment was defined as a decline of more than one standard deviation in
20% of tests. Variables significantly (p < 0.05) associated with
postoperative cognitive impairment are baseline psychometric scores,
largest arterial-venous oxygen difference, and years of education. Jugular
bulb hemoglobin saturation is significant if it replaces arterial-venous
oxygen difference in the model. Factors correlated with jugular bulb
saturation at normothermia were cerebral metabolic rate of oxygen
consumption (r = -0.6; p < 0.0005), cerebral blood flow (r = 0.4; p <
0.0005), oxygen delivery (r = 0.4; p < 0.0005), and mean arterial
pressure (r = 0.15; p < 0.05). Three measures were significantly related
to desaturation at normothermia and at hypothermia as well: greater
cerebral oxygen extraction, greater arterial-venous oxygen difference, and
lower ratio of cerebral blood flow to arterial-venous oxygen difference. We
conclude that cerebral venous desaturation occurs during cardiopulmonary
bypass in 17% to 23% of people and is associated with impaired
postoperative cognitive test performance.
ARTICLES
Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass
Department of Anesthesiology, Duke University Hospital, Durham, North Carolina 27710.
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W. A. C. Mutch, L. N. Ryner, P. Kozlowski, G. Scarth, R. K. Warrian, G. R. Lefevre, T. G. Wong, D. B. Thiessen, L. G. Girling, L. Doiron, et al. Cerebral Hypoxia During Cardiopulmonary Bypass: A Magnetic Resonance Imaging Study Ann. Thorac. Surg., September 1, 1997; 64(3): 695 - 701. [Abstract] [Full Text]
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W. A. C. Mutch, M. F. Newman, N. D. Croughwell, and J. G. Reves Jugular Bulb Saturation and Cognitive Dysfunction After Cardiopulmonary Bypass Ann. Thorac. Surg., July 1, 1995; 60(1): 231 - 232. [Full Text]
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M. F. Newman, N. D. Croughwell, J. A. Blumenthal, E. Lowry, W. D. White, W. Spillane, R. D. Davis Jr, D. D. Glower, L. R. Smith, E. P. Mahanna, et al. Predictors of Cognitive Decline After Cardiac Operation Ann. Thorac. Surg., May 1, 1995; 59(5): 1326 - 1330. [Abstract] [Full Text]
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