Jugular venous oxygenation during hypothermic cardiopulmonary bypass in patients at risk for abnormal cerebral autoregulation: influence of alpha-Stat versus pH-stat blood gas management.
In a prospective, randomized study of cardiac surgical patients at risk for impaired cerebral blood flow autoregulation, we compared alpha-stat and pH-stat blood gas management. The 40 patients enrolled had age >70 yr, diabetes, prior stroke, or uncontrolled hypertension. During hypothermia and early rewarming, jugular oxygen tensions were significantly lower in alpha-stat patients (n = 12) than pH-stat patients (n = 19; P < 0.05). During rewarming, jugular venous desaturation (i.e., SjvO(2) <50%) occurred in 6 of 12 alpha-stat patients, but no pH-stat patients (P = 0.0006). Patients at risk for poor cerebral autoregulation have higher oxygen tensions and saturations if pH-stat blood gas management is used during cardiopulmonary bypass.
Department of Cardiothoracic Anesthesia, San Antonio Uniform Health Education Consortium, San Antonio, Texas, USA.
Lance R
LR
Hoover
Radhika
R
Dinavahi
Wei-Ping
WP
Cheng
John R
JR
Cooper
Maria Rosa
MR
Marino
Tyler C
TC
Spata
Gaile L
GL
Daniels
William K
WK
Vaughn
Nancy A
NA
Nussmeier
D000136:Acid-Base Equilibrium; D000368:Aged; D001784:Blood Gas Analysis; D001831:Body Temperature; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006706:Homeostasis; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D018570:Risk Assessment
D010100:Oxygen