title: Increasing mean arterial blood pressure has no effect on jugular venous oxygen saturation in insulin-dependent patients during tepid cardiopulmonary bypass.
abstract: Preexisting diabetes mellitus is one of the major factors related to adverse postoperative neurological disorders after cardiac surgery. In previous reports, we found that diabetic patients more often experienced cerebral desaturation than nondiabetic patients during normothermic cardiopulmonary bypass (CPB). The purpose of this study was to examine the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen hemoglobin saturation (SjvO2) during tepid CPB in diabetic patients. We studied 20 diabetic patients scheduled for elective coronary artery bypass graft surgery and, as a control, 20 age-matched nondiabetic patients. After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO2. After measuring the baseline partial pressure of the arterial and jugular venous blood gases and cardiovascular hemodynamic values, MAP was increased by the repeated administration of a 10-microg bolus of phenylephrine until it reached 100% of baseline values. There was a significant difference in SjvO2 value between the Diabetic and CONTROL GROUPs after the administration of phenylephrine (Diabetic group, 56% +/- 6%;
  
  
  METHODS
  60% +/- 4%) (P < 0.05). There was a significant difference in the arterial-jugular oxygen content difference value between the Diabetic and CONTROL GROUPs after the administration of phenylephrine (diabetic group, 4.9% +/- 0.6%; CONTROL GROUP, 4.5% +/- 0.4%) (P < 0.05). We subdivided the Diabetic group into three groups (Diet Therapy group [n = 4], Glibenclamide group [n = 10], and Insulin-Dependent group [n = 6]). There was a significant difference in the mean slopes of SjvO2 versus cerebral perfusion pressure for increasing cerebral perfusion pressure between the Insulin-Dependent group and the other groups (Dunnett test: P = 0.04). Increasing MAP had no effects on the SjvO2 value in insulin-dependent patients during tepid CPB.
  
  
  CONCLUSIONS
  We examined the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen saturation (SjvO2) during tepid cardiopulmonary bypass in diabetic patients and found that increasing MAP had no effect on the SjvO2 value in insulin-dependent patients.
authors.affiliation: Department of Anesthesiology and Reanimatology and Division of Intensive Care Unit, School of Medicine, Gunma University, Gunma, Japan. kadoi@med.gunma-u.ac.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kadoi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshikawa
authors.forename: Fumio
authors.initials: F
authors.lastname: Goto
authors.forename: Nao
authors.initials: N
authors.lastname: Fujita
authors.forename: Fumio
authors.initials: F
authors.lastname: Kunimoto
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000494:pharmacology; D000368:Aged; D000758:Anesthesia; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000502:physiology*; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000502:physiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007328:Insulin / Q000097:blood*; D007601:Jugular Veins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010656:Phenylephrine / Q000494:pharmacology
chemical_list: D000316:Adrenergic alpha-Agonists; D007328:Insulin; D010656:Phenylephrine; D010100:Oxygen