Jugular bulb oxyhemoglobin desaturation, S100beta, and neurologic and cognitive outcomes after coronary artery surgery.
We reported that a decline in cognitive performance 3 mo after coronary artery bypass grafting surgery is associated with palpable aortic atheroma, but not postoperative jugular bulb oxyhemoglobin saturation (SjO2) <50%. However, the effect of SjO2 on clinical neurologic findings is not known. S100beta is a possible surrogate biochemical marker of brain injury, and we report here the scored clinical neurologic findings in 98 patients from our previous study in relation to SjO2, cognitive performance, aortic atheroma, and S100beta. Patients underwent a scored neurologic examination and cognitive assessment the day before and 3 mo after coronary artery bypass grafting surgery. Intraoperatively, intermittent blood sampling was performed, and postoperatively, the area under the curve describing SjO2 <50% in relation to time was calculated from continuous jugular bulb reflectance oximetry. Palpation was used to assess the ascending aorta for the presence of atheroma. The jugular bulb concentration of S100beta was measured 6 h after completion of surgery. The neurologic score 3 mo after surgery did not correlate with either intra- or postoperative SjO2 (r = 0.111, P = 0.278; and r = -0.074, P = 0.467, respectively). The main determinant of neurologic score at 3 mo was the preoperative neurologic score (r(2) = 0.63, P < 0.001), whereas palpable atheroma of the ascending aorta made a small but significant contribution (r(2) = 0.034, P = 0.004). Neurologic and cognitive scores correlated before surgery (r = 0.226, P = 0.022) and at 3 mo after surgery (r = 0.348, P < 0.001). A preoperative neurologic deficit of two or more had a small but significant negative effect on cognitive performance at 3 mo (standardized beta = -0.097, P = 0.018). There was a significant univariate correlation between S100beta and the 3-mo neurologic score (r = -0.232, P < 0.05), but not a multivariate correlation (beta = -0.090, P = 0.156).


CONCLUSIONS
Intraoperative jugular bulb oxyhemoglobin saturation (SjO2) and postoperative SjO2 <50% do not have an important influence on long-term neurologic outcome after coronary artery bypass graft surgery. Subtle preoperative neurology is associated with long-term cognitive decline, and aortic atheroma is a risk factor for both cognitive and neurologic decline.
Robson
M J
MJ
Department of Anaesthesia, St. Vincent's Hospital, Melbourne, Australia. mjarobson@hotmail.com
Alston
R P
RP
Deary
I J
IJ
Andrews
P J
PJ
Souter
M J
MJ
D001161:Arteriosclerosis / Q000097:blood; D015992:Body Mass Index; D003072:Cognition Disorders / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007601:Jugular Veins / Q000502:physiology*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010108:Oxyhemoglobins / Q000378:metabolism*; D011183:Postoperative Complications / Q000209:etiology* / Q000523:psychology; D012044:Regression Analysis; D009418:S100 Proteins / Q000378:metabolism*
D010108:Oxyhemoglobins; D009418:S100 Proteins; D019344:Lactic Acid