title: Cerebral oxygenation impairment and S-100β protein release during off-pump coronary artery revascularization.
abstract: OBJECTIVE
  To elucidate the magnitude of global cerebral oxygenation impairment, using cerebral oxygenation indices and S-100β protein as potential markers, during off-pump coronary artery bypass grafting (OPCAB).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary cardiac center.
  
  
  METHODS
  Thirty-five patients undergoing OPCAB.
  
  
  METHODS
  Jugular bulb and arterial blood samples for cerebral oxygenation indices (arterial oxygen and carbon dioxide partial pressures, jugular bulb oxygen saturation, arterial-jugular bulb oxygen content, arterial-jugular carbon dioxide partial pressure, brain oxygen extraction ratio, and estimated respiratory quotient) and S-100β protein determination were collected at anesthesia induction; anterior, inferior, and posterior wall anastomoses; after sternal closure; and 6 hours postoperatively. Concomitant hemodynamic data were obtained. The S-100β determination was extended to 12 and 24 hours postoperatively.
  
  
  RESULTS
  Heart positioning for the target vessel exposure induced significant hemodynamic deterioration (p < 0.001). Although cerebral oxygenation indices were influenced adversely by a low-cardiac-output state mainly during vertical heart dislocation (p < 0.001), they remained within normal limits. Hemodynamic and cerebral oxygenation statuses reverted to baseline within 6 hours postoperatively. Similarly, S-100β jugular bulb and arterial protein levels presented a gradual increase, which peaked by the end of surgery (means, 0.54 and 0.62 μg/L, respectively; p < 0.001) and then decreased by the first postoperative day. Jugular bulb-arterial S-100β levels were maximized during posterior wall anastomosis (0.098 μg/L; p < 0.01).
  
  
  CONCLUSIONS
  Although exposure of the 3 main coronary arteries during OPCAB promotes derangement of the cerebral oxygen indices and S-100β release, this seems to be transient, remains within the near-normal range, and is reversible almost completely 6 hours postoperatively.
authors: Department of Anesthesiology and Intensive Care, AHEPA University Hospital, Thessaloniki, Greece. tsaousig@otenet.gr
authors: Georgia G
authors: GG
authors: Tsaousi
authors: Antonis A
authors: AA
authors: Pitsis
authors: Despina V
authors: DV
authors: Deliaslani
authors: Ekaterini N
authors: EN
authors: Amaniti
authors: Konstantinos A
authors: KA
authors: Karakoulas
authors: Dimitrios G
authors: DG
authors: Vasilakos
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D015415:Biomarkers; D001923:Brain Chemistry / Q000502:physiology*; D002303:Cardiac Output, Low / Q000150:complications; D003072:Cognition Disorders / Q000209:etiology; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D009414:Nerve Growth Factors / Q000378:metabolism*; D009483:Neuropsychological Tests; D010101:Oxygen Consumption / Q000502:physiology*; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins