title: The relationship between prolonged cerebral oxygen desaturation and postoperative outcome in patients undergoing coronary artery bypass grafting.
abstract: 58 patients who underwent on-pump coronary artery bypass graft surgery were evaluated for changes in regional cerebral oxygen saturation (rSO2) measured by near infrared spectroscopy (NIRS). If rSO2 during the operation fell to more than 20% under the baseline, standardized interventions were undertaken to maintain rSO2. Despite those interventions, in some cases we observed inability to maintain rSO2 above this threshold. Therefore we divided patients in two subgroups: 1. without prolonged rSO2 desaturation; 2. with prolonged rSO2 desaturation (area under the curve >150 min% for rSO2<20% of baseline and >50 min% for rSO2<50% of absolute value). The data were analyzed to determine whether there were major differences in outcome of these two groups. 18 out of 58 patients (31%) had prolonged rSO2 desaturation during operation. There was significantly higher number of diabetic patients in group with prolonged rSO2 desaturation (p=0.02). Intraoperative data revealed significantly more blood consumption during cardiopulmonary bypass (p=0.007) and the need for inotropes (p=0.04) in desaturation group. Three patients in prolonged desaturation group and no one in another group had stroke, coma or stupor (p=0.03). Logistic regression analysis revealed diabetes mellitus and age as predictors for prolonged rSO2 desaturation. We concluded that prolonged intraoperative rSO2 desaturation is significantly associated with worse neurological outcome in patients - nonresponders to standardized interventions for prevention of rSO2 desaturation.
authors.affiliation: University of Zagreb, Zagreb University Hospital Center, Department of Anesthesiology, Reanimatology and Intensive Care, Zagreb, Croatia. zcolak2000@yahoo.com
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Colak
authors.forename: Marko
authors.initials: M
authors.lastname: Borojević
authors.forename: Visnja
authors.initials: V
authors.lastname: Ivancan
authors.forename: Rajka
authors.initials: R
authors.lastname: Gabelica
authors.forename: Bojan
authors.initials: B
authors.lastname: Biocina
authors.forename: Visnja
authors.initials: V
authors.lastname: Majerić-Kogler
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen