Warming During Cardiopulmonary Bypass Is Associated With Jugular Bulb Desaturation

Croughwell, Narda D.; Newman, MF; Quill, Timothy J.; Blumenthal, James A.; Schniebolk, S; Robinson, Marnie R.; White, William D.; Lu, Junlan; Moon, Richard E.; Rêves, J. G.

doi:10.1213/00000539-199002001-00072

Cited by 24 publications

(27 citation statements)

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“…168 Nakajima et al 167 observed a decrease in SjO2 only during the rewarming period and the decrease of saturation was related to the "rewarming speed" indicating that this may be a critical period for cerebral oxygen supply and demand. This study has similar findings to that of Croughwell et al 169 Other workers, however, have found decreases in SjO2 during brain cooling 37 (see Temperature Monitoring).…”

Section: Transcranial Doppler (Tcd)supporting

confidence: 92%

Monitoring during paediatric cardiac anaesthesia

Purday

1994

Can J Anaesth

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Monitoring of paediatric anaesthesia has become increasingly more complex in recent years (precordial, oesophageal or paratracheal). Specialized monitoring includes the monitoring of mixed venous oxygenation saturation (S~O2) which is being increasingly used within the critical care area. Transoesophageal echocardiography (TOE) has become accepted in adult cardiac surgery particularly in the fields of mitral valve repair and aortic root surgery, where it allows immediate assessment of the adequacy of repair. The place of TOE in congenital heart disease is now becoming more clearly defined. Cerebral function monitoring is an area of a great deal of research and several new monitoring methods are under review. The use of the thromboelastogram in monitoring coagulation has been found to decrease blood and fluid replacement during liver transplantation and its use during cardiac surgery is increasing. Other end organs that are affected by cardiopulmonary bypass (CPB) include the gut; liver and immune system, possibly leading to multi-organ failure in some cases, and interest is being shown in their monitoring.The purpose of this review is to present the recent publications relating to specific areas of both standard and specialized monitoring and indicate areas where these monitors may prove particularly useful to the practitioner involved in the care of paediatric cardiac patients. Routine monitoring ElectrocardiogramThe ECG displays the electrical activity of the heart. Abnormalities in the ECG can reflect alterations in rate or rhythm and changes in the ST segment may incidate underlying ischaemia. The normal ECG in childhood changes with age and shows several differences from the adult, particularly in the first few years of life where the right ventrical mass is dominant. There are several general changes that occur with increasing age (Table I). Heart rate (HR), frontal plane QRS vector (axis), PR interval, R wave heights and T waves are some of the factors that alter with age (Table II) and the reader is referred to a more specialized review for further information. 1,2 In adult cardiac surgery there has been investigation of perioperative myocardial ischaemia, its prognosis, and the best way of detecting it. 3,4 In children, however, there has been little work looking at the ST segment. Bell et al. ~ reported three cases of ST changes in neonates consistent with myocardial ischaemia. The first case involved a child of 26 wk who developed ST changes during awake laryngoscopy and lung retraction that were presumed to be related to myocardial hypoxia, although pulse oximetry readings were not mentioned. In the second case, ST changes improved on starting trinitroglycerine, isoproterenol and dopamine and in the third were related to ectiocardiographic changes. Cherian and Rao 6 associate the ST segment with the adequacy of coronary blood flow during the arterial switch operation for transposition. Observing leads I and V 5 for the left coronary and lead II for the right, greater than 1 mm elevation for more tha...

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Section: Transcranial Doppler (Tcd)supporting

confidence: 92%

Monitoring during paediatric cardiac anaesthesia

Purday

1994

Can J Anaesth

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“…Rewarming has been shown to be associated with decreased jugular bulb saturations, a predictor of adverse neurological outcome. 28,29 Any hypoperfusion or loss of autoregulation during this period would lead to a mismatch between oxygen delivery and the heightened cerebral metabolic demands brought about by the rise in temperature. The central nervous system compensates for any shortfall of oxygen supply by increasing the amount of oxygen extraction, which appears as a widened cerebral arterial-venous oxygen content difference.…”

Section: Discussionmentioning

confidence: 99%

Effect of Apolipoprotein E Genotype on Cerebral Autoregulation During Cardiopulmonary Bypass

Mathew

Mackensen

et al. 2001

Stroke

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Background and Purpose-The presence of the apolipoprotein E ⑀4 (apoE4) allele has been associated with cognitive decline after cardiac surgery. We compared autoregulation of cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRO 2 ), and arterialϪvenous oxygen content difference [C(AϪV)O 2 ], during cardiopulmonary bypass (CPB) in patients with and without the apoE4 allele to help define the mechanism of association with cognitive decline. Methods-One hundred fifty-four patients underwent coronary artery bypass grafting with CPB, nonpulsatile flow, and ␣-stat management. CBF was measured by using 133 Xe washout methods. C(AϪV)O 2 , CMRO 2 , and oxygen delivery were calculated. Pressure-flow autoregulation was tested by using 2 CBF measurements at stable hypothermia: the first at stable mean arterial pressure (MAP) and the second 15 minutes later, when MAP had increased or decreased Ն20%.Metabolism-flow autoregulation was tested by varying the temperature and measuring the coupling of CBF and CMRO 2 . Results-In patients with (nϭ41) or without (nϭ113) the apoE4 allele, there were no differences in CBF, CMRO 2 , C(AϪV)O 2 , pressure-flow and metabolism-flow autoregulation corrected for age, gender, non-insulin-dependent diabetes, hemoglobin, CPB time, and temperature. Conclusions-We conclude that apoE genotype does not affect global CBF and oxygen delivery/extraction during CPB, which suggests that other mechanisms are responsible for the apoE isoform-related neurocognitive dysfunction seen in patients undergoing CPB.

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“…Furthermore, cerebral blood flow (CBF) significantly decreases in patients with DHA during the re-warming phase. 11 If the cerebral circulation was unable to regulate oxygen delivery after DHA, the brain would be at an increased risk of hypoxic injury during episodes of hypoxemia in the re-warming phase. 12 Therefore, we speculate that the potential mismatches in flow/metabolism after DHA are most likely expressed during rapid temperature or perfusion changes such as that which occurs during rewarming.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Less Invasive Proximal Arch Replacement With Moderate Hypothermic Circulatory Arrest Followed by Aggressive Rapid Re-Warming in Emergency Surgery for Type A Acute Aortic Dissection

Hata

Suzuki

Sezai

et al. 2009

Circ J

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Circ J 2009; 73: 69 -72 urgical mortality rates during emergency operation for type A acute aortic dissection (AAD) are still estimated to range from 9 to 30%, and is associated with postoperative complications such as cerebral injury, bleeding, renal failure, and pneumonia caused by longer operation time (>6 h), longer cardiopulmonary bypass (CPB) time (>4 h), deep hypothermia, and circulatory arrest (DHA). 1 If surgical stress could be minimized by shortening the duration of brain ischemic stress, CPB and operative procedures, the surgical outcome for patients with AAD could be further improved. In the majority of patients, an ascending or hemiarch replacement is sufficient, as the intimal tear is generally located in the ascending or the proximal aortic arch. 2 Recently, it has been reported that moderate hypothermic arrest at 26-28°C without any adjunctive cerebral protection was safe in patients undergoing hemiarch aortic replacement. 3 We have established a new procedure for proximal arch replacement for patients with moderate hypothermic arrest without cerebral perfusion, which is followed by aggressive rapid re-warming to shorten the duration of brain ischemia, CPB, and overall surgery. We report here on the initial results of this procedure for an octogenarian with AAD 4 and have since performed this procedure for all the patients undergoing an emergency proximal arch replacement for AAD. The aim of this study is to assess the mid-term outcome of our newly modified technique. MethodsBetween March 2002 and February 2008, 114 patients underwent emergency surgery for AAD at our institution. The extent of aortic replacement was decided based on the location of the intimal tear (tear-oriented surgery). Ascending/hemiarch aortic replacement was performed in patients with the intimal tear localized in the ascending aorta or in the lesser curvature of the transverse aortic arch proximal to the left subclavian artery. In this series, 85 (74.6%) consecutive patients underwent ascending/hemiarch aortic replacement. We retrospectively reviewed these patients. Institutional review board approval was provided before publication of this manuscript and reporting of the information. Fifty patients (58.8%) were female, and the average age was 66.9±12.0 years, ranging from 36 to 90 years.

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Warming During Cardiopulmonary Bypass Is Associated With Jugular Bulb Desaturation

Cited by 24 publications

References 0 publications

Monitoring during paediatric cardiac anaesthesia

Monitoring during paediatric cardiac anaesthesia

Effect of Apolipoprotein E Genotype on Cerebral Autoregulation During Cardiopulmonary Bypass

Outcome of Less Invasive Proximal Arch Replacement With Moderate Hypothermic Circulatory Arrest Followed by Aggressive Rapid Re-Warming in Emergency Surgery for Type A Acute Aortic Dissection

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