Jugular bulb desaturation during off-pump coronary artery bypass surgery.
OBJECTIVE
Off-pump coronary artery bypass grafting surgery (OPCAB) frequently results in significant jugular bulb desaturation. Although jugular bulb desaturation during OPCAB may be associated with postoperative cerebral injury, routine jugular bulb oximetry appears to be invasive and expensive. We hypothesized that intraoperative hemodynamic compromise during OPCAB due to cardiac displacement is associated with jugular bulb desaturation which correlates with specific hemodynamic and physiological changes.


METHODS
Hemodynamic and physiological data were measured at the following points: (1) before anastomosis of the coronary artery (baseline); (2) during anastomosis of the left anterior descending artery; (3) during anastomosis of the circumflex branch or posterior descending artery; and (4) after chest closure. Arterial, mixed venous, and jugular venous bulb blood gas analyses were performed serially.


RESULTS
Jugular bulb desaturation (<or=50%) frequently occurred during surgical displacement of the heart. Mixed venous oxygen saturation (S(VO2)), partial pressure of carbon dioxide (Pa(CO2)), and central venous pressure (CVP) showed a significant relationship with jugular bulb oxygen saturation (r = 0.45) by multivariate linear regression analysis. Multivariate logistic regression analysis also demonstrated that S(VO2) <or= 70%, Pa(CO2) <or= 40 mmHg, and CVP >or= 8 mmHg were likely predictors of the occurrence of jugular bulb desaturation.


CONCLUSIONS
Changes in S(VO2) and Pa(CO2) were associated with jugular bulb oxygen saturation, and S(VO2) <or= 70%, Pa(CO2) <or= 40 mmHg, and CVP >or= 8 mmHg had a significant odds ratio for jugular bulb desaturation. We suggest that achieving normal values of S(VO2), Pa(CO2) and CVP may be important to prevent cerebral desaturation during OPCAB.
Miura
Norikazu
N
Department of Anesthesiology, National Cardiovascular Center, Suita, Osaka, Japan.
Yoshitani
Kenji
K
Kawaguchi
Masahiko
M
Shinzawa
Masahide
M
Irie
Tomoya
T
Uchida
Osamu
O
Ohnishi
Yoshihiko
Y
Mackensen
G Burkhard
GB
D000368:Aged; D001831:Body Temperature / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002496:Central Venous Pressure / Q000502:physiology; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood* / Q000209:etiology*; D007601:Jugular Veins / Q000502:physiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*
D002245:Carbon Dioxide; D010100:Oxygen