Using jugular bulb oxyhemoglobin saturation to guide onset of deep hypothermic circulatory arrest does not affect post-operative neuropsychological function.
OBJECTIVE
Deep hypothermic circulatory arrest (DHCA) is commonly used during thoracic aortic surgery, and is initiated only after a sufficient degree of cerebral hypothermia is induced. The criteria for initiating DHCA vary among institutions: most centers use temperature criteria, some use electroencephalography, and a minority use jugular bulb oxyhemoglobin saturation SjO(2) criteria. The purpose of this study was to determine whether the use of SjO(2) monitoring to guide the onset of DHCA was associated with better post-operative neuropsychological outcome.


METHODS
Sixty-one thoracic aortic surgical patients underwent both pre- and post-operative neuropsychological testing. Patients were divided into three groups: (1) those with SjO(2)> or =95% at DHCA onset; (2) those with SjO(2)<95% at DHCA onset; and (3) those without SjO(2) monitoring.


RESULTS
There were no statistically significant differences in the incidence of post-operative decline in neuropsychological function among the three groups of patients. Patients in whom SjO(2) data were used to guide onset of DHCA had lower esophageal and bladder temperatures at that time compared with patients without SjO(2) monitoring.


CONCLUSIONS
Monitoring of SjO(2) had no apparent effect upon post-operative neuropsychological outcome, and there were no trends in our small patient cohort suggesting differences that our study was not adequately powered to detect. Use of SjO(2) monitoring was associated with more profound hypothermia prior to DHCA due to more prolonged cooling in attempts to bring the SjO(2) above the 95% threshold. Using our institutional cooling protocol, SjO(2) monitoring does not appear to increase neuroprotection in patients undergoing DHCA for thoracic aortic repairs.
Reich
David L
DL
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA. david.reich@msnyuhealth.org
Horn
Loren M
LM
Hossain
Sabera
S
Uysal
Suzan
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000601:surgery*; D001288:Attention / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000503:physiopathology; D008606:Mental Processes / Q000502:physiology; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D009483:Neuropsychological Tests; D010108:Oxyhemoglobins / Q000032:analysis*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000523:psychology*; D011597:Psychomotor Performance / Q000502:physiology
D010108:Oxyhemoglobins