Comparison of two sites of inflow pressure measurement during retrograde cerebral perfusion.
OBJECTIVE
To determine whether internal jugular venous valves influence inflow pressure during retrograde cerebral perfusion.


METHODS
Prospective study.


METHODS
Community hospital, university setting, single institution.


METHODS
Ten patients undergoing reconstructive aortic arch surgery with profound hypothermic circulatory arrest.


METHODS
During retrograde cerebral perfusion, inflow pressure was continuously measured at 2 separate sites relative to the left internal jugular venous valve (ie, superior vena cava inflow catheter [infravalvular pressure] and rostral left internal jugular vein [supravalvular pressure]).


RESULTS
Infravalvular pressure of 29.8 +/- 3.5 mmHg and supravalvular pressure of 22.7 +/- 0.8 mmHg were significantly different (mean difference, 7.1 +/- 3.6 mmHg; p = 0.041). In 8 patients, the pressure difference was <6 mmHg; whereas in 2 patients, the pressure difference was >20 mmHg. Bland and Altman analysis revealed 95% limits of agreement on mean bias of -12.9 to 27.8 mmHg.


CONCLUSIONS
Internal jugular venous valves can obstruct retrograde cerebral perfusion inflow, manifest by an inflow pressure difference between the superior vena cava and internal jugular vein. In the presence of competent internal jugular venous valves, measurement of inflow pressure in the superior vena cava may be an inaccurate estimate of actual cerebral perfusion pressure. Internal jugular vein pressure should be monitored to avoid inadvertent cerebral hypoperfusion.
Loubser
P G
PG
Department of Anesthesiology, Baylor College of Medicine and the Methodist Hospital, Houston, TX, USA.
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D007601:Jugular Veins / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D014656:Vascular Surgical Procedures; D014683:Vena Cava, Superior / Q000502:physiology*