Comparison of Alpha-Stat and pH-Stat Cardiopulmonary Bypass in Relation to Jugular Venous Oxygen Saturation and Cerebral Glucose-Oxygen Utilization

Kızıltan, H. Tarık; Baltal, Mehmet; Bilen, Ahmet; Seydaoğlu, Gülşah; Incesoz, Muzaffer; Taşdelen, Atılay; Aşlamacı, Sait

doi:10.1213/01.ane.0000048826.67870.85

Cited by 22 publications

(9 citation statements)

References 25 publications

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“…19 -21 However, CBF is dependent upon arterial blood pressure during pH-stat management. 18,20,22 It has been suggested that partial loss of cerebral autoregulation with pH-stat management may result in a cerebral "steal" phenomenon in patients with cerebrovascular disease and that increased CBF during CPB may result in an increased embolic load, thus potentially increasing the risk of cerebral injury. 18,[22][23][24][25] Traditional thinking holds that ␣-stat management better preserves cerebral flow-metabolism coupling and autoregulation of the cerebral vasculature 18 and that, during hypothermia, decreased cerebral metabolic demand and unchanged CBF cause SjvO 2 to increase, indicating "luxury perfusion."…”

Section: Discussionmentioning

confidence: 99%

Jugular Venous Oxygenation During Hypothermic Cardiopulmonary Bypass in Patients at Risk for Abnormal Cerebral Autoregulation: Influence of α-Stat Versus pH-Stat Blood Gas Management

Hoover

Dinavahi²,

Cheng³

et al. 2009

Anesthesia &Amp; Analgesia

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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.

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Section: Discussionmentioning

confidence: 99%

Jugular Venous Oxygenation During Hypothermic Cardiopulmonary Bypass in Patients at Risk for Abnormal Cerebral Autoregulation: Influence of α-Stat Versus pH-Stat Blood Gas Management

Hoover

Dinavahi²,

Cheng³

et al. 2009

Anesthesia &Amp; Analgesia

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“…More recently, Kiziltan et al. (20) found significantly higher jugular venous oxygen saturations after 30 min of CPB at 27°C in patients managed according to the pH‐stat strategy compared with the alpha‐stat strategy (86.2% vs. 70.6%, respectively). Nevertheless, the incidence of desaturation during warming did not significantly differ between the two groups.…”

Section: Discussionmentioning

confidence: 98%

Comparison of pH‐Stat Versus Alpha‐Stat During Hypothermic Cardiopulmonary Bypass in the Prevention and Control of Acidosis in Cardiac Surgery

Piccioni

Leirner

Auler³

2004

Artificial Organs

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“…59 Subsequently, cerebral autoregulation disappears and the risk of embolic events increases. 11,60,61 During rewarming period, and after CPB with moderate hypothermia, the alpha stat strategy is preferred to preserve an adequate cerebral oxygen supply demand balance and reduce acidosis.…”

Section: Cerebral Hypoperfusionmentioning

confidence: 99%

Neurological Damage Related to Cardiac Surgery

Carrascal¹,

Peral²

2010

The Neurologist

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Even in milder cases, neurologic complications related to cardiac surgery increase mortality, hospitalization time, and rehabilitation costs, and so contribute to the decrease in quality of life. The incidence of neurologic complications has remained unchanged during the last years, despite age and comorbidity increasing. Improvement in technical approaches has probably contributed to maintain these percentages. Although most of the complications may be related to cardiopulmonary bypass, others factors are also involved. Identifying high risk patients could reduce incidence of complications within high risk groups, but this is probably an insufficient preventive strategy. In a population progressively older and presumably affected by an increasing number of diseases, preventive strategies should be focused on 3 aspects: first, technical improvements in cardiac surgery and cerebral protection; second, pharmacologic therapy; and, finally, identification of reliable techniques to evaluate neuropsychological dysfunction after cardiac surgery. Future efforts will be necessary to identify surrogate markers of neurologic damage and its functional outcome, perhaps related to genetic susceptibility.Only with all of these instruments, really effective preventive or palliative strategies could be planned and applied.

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Comparison of Alpha-Stat and pH-Stat Cardiopulmonary Bypass in Relation to Jugular Venous Oxygen Saturation and Cerebral Glucose-Oxygen Utilization

Cited by 22 publications

References 25 publications

Jugular Venous Oxygenation During Hypothermic Cardiopulmonary Bypass in Patients at Risk for Abnormal Cerebral Autoregulation: Influence of α-Stat Versus pH-Stat Blood Gas Management

Jugular Venous Oxygenation During Hypothermic Cardiopulmonary Bypass in Patients at Risk for Abnormal Cerebral Autoregulation: Influence of α-Stat Versus pH-Stat Blood Gas Management

Comparison of pH‐Stat Versus Alpha‐Stat During Hypothermic Cardiopulmonary Bypass in the Prevention and Control of Acidosis in Cardiac Surgery

Neurological Damage Related to Cardiac Surgery

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