Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery

Slater, James P.; Guarino, Theresa; Stack, Jessica; Vinod, Kateki; Bustami, Rami; Brown, John; Rodriguez, Alejandro; Magovern, Christopher J.; Zaubler, Thomas S.; Freundlich, Kenneth; Parr, Grant V.S.

doi:10.1016/j.athoracsur.2008.08.070

Cited by 550 publications

(454 citation statements)

References 24 publications

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“…rSO 2 monitoring can be continuous, noninvasive, and convenient, with high sensitivity and specificity using dual detector proprioceptors. The mixed transmitted intensity of oxygenated hemoglobin and reduced hemoglobin was detected to establish the oxygen saturation of local hemoglobin whose normal value is 55%-75%, and may rise on inhalation of pure oxygen (Casati et al, 2005;Farag et al, 2006;Slater et al, 2009). The arteriovenous blood flow ratio in the cerebral blood volume is 15:85, so rSO 2 mainly represents cerebral venous oxygen saturation and can reflect the balance changes in oxygen supply and consumption.…”

Section: Discussionmentioning

confidence: 99%

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Investigation of one-lung ventilation postoperative cognitive dysfunction and regional cerebral oxygen saturation relations

Liu

et al. 2015

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To explore the relationship of postoperative cognitive dysfunction (POCD) in one-lung ventilation (OLV) patients and regional cerebral oxygen saturation (rSO 2 ). Methods: Twenty-nine male and twenty-one female cases of OLV received thoracic surgery, with American Standards Association (ASA) physical status being at Grades I-III. Neuropsychological tests were performed on the day before operation and 7 d after operation, and there was an intraoperative continuous monitoring of rSO 2 . The values of rSO 2 before anesthesia induction (t 1 ), at the beginning of OLV (t 2 ), and at the time of OLV 30 min (t 3 ), OLV 60 min (t 4 ), the end of OLV (t 5 ), and the end of surgery (t 6 ) were recorded. The intraoperative average of rSO 2 ( 2 rSO ), the intraoperative minimum value of rSO 2 (rSO 2, min ), and the reduced maximum percentage of rSO 2 (rSO 2, %max ) when compared with the baseline value were calculated. The volume of blood loss, urine output, and the amount of fluid infusion was recorded. Results: A total of 14 patients (28%) in the 50 cases suffered from POCD. The values of mini-mental state examination (MMSE), the digit span and the digit symbol on the 7th day after the operation for POCD in OLV patients were found to be significantly lower than those before the operation (P<0.05). The values of MMSE and vocabulary fluency scores were significantly lower than those in the non-POCD group (P<0.05). The values of rSO 2 in the POCD group of OLV patients at t 2 and t 3 and the values of rSO 2 in the non-POCD group at t 2 were found to be significantly higher than those at t 1 (P<0.05). The values of rSO 2, %max in the POCD group were significantly higher than those in the non-POCD group (P<0.05). When the value of rSO 2, %max is more than 10.1%, it may act as an early warning index for cognitive function changes. Conclusions: POCD after OLV may be associated with a decline in rSO 2 .

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Section: Discussionmentioning

confidence: 99%

“…Proposed interventions to modify these factors include monitoring of regional cerebral oxygen saturation (rSO 2 ) (Casati et al, 2005;Slater et al, 2009). However, evidence is lacking on any association of intraoperative rSO 2 with patients' outcome and POCD using structured cognitive testing.…”

Section: Introductionmentioning

confidence: 99%

Investigation of one-lung ventilation postoperative cognitive dysfunction and regional cerebral oxygen saturation relations

Liu

et al. 2015

J. Zhejiang Univ. Sci. B

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“…As brain oxygen demand remains relatively stable under anesthesia, changes in SctO 2 typically represent reductions in cerebral oxygen supply, which are often due to reductions in blood pressure, carbon dioxide partial pressure, cardiac output, hemoglobin concentration, and/or arterial oxygen content. [5][6][7][8][9][10][11][12] The accuracy of SctO 2 measurements under a variety of clinical conditions is essential if appropriate assessment and management of brain oxygenation is to be possible. Nevertheless, previous studies suggest that extracranial contamination can influence the measurement of SctO 2 and result in measured values that do not entirely reflect the status of oxygenation in the brain.…”

Section: Résumémentioning

confidence: 99%

Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers

Greenberg

Murphy

Shear

et al. 2015

Can J Anesth/J Can Anesth

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Purpose Previous studies have found that most cerebral oximeters are subject to inaccuracies secondary to extracranial contamination of the cerebral oximetric signals. We hypothesized that the more advanced secondgeneration FORE-SIGHT ELITE cerebral oximeter would be significantly less affected by extracranial tissue hypoxemia than the more widely used first-generation INVOS TM 5100C monitor. Methods Twenty healthy volunteers aged 18-45 yr had the INVOS and FORE-SIGHT probes placed on their forehead in a random sequence while in the supine position. A pneumatic head cuff was then placed around each volunteer's head just below both the oximeter and a concomitantly placed scalp forehead pulse oximeter probe. The subjects' scalp cerebral oxygen saturation (SctO 2 ) values were measured and compared using the two different devices in sequence, both before and after scalp tissue ischemia was induced by the pneumatic cuff. Results Extracranial ischemia resulted in a significant reduction in SctO 2 values from baseline in both devices. The INVOS 5100C recorded a median [interquartile range] decrease in SctO 2 from baseline at five minutes of 15.1% [12.6 -17.6], while that recorded by the FORESIGHT ELITE device was 8.6% [4.0 -12.3] at five minutes (median difference, 7.9%; 99% confidence interval, 1.9 to 16.5; P = 0.002). Conclusion Updated technological algorithms employed in the FORE-SIGHT ELITE cerebral oximeter may be responsible for less extracranial contamination than was observed in the previous-generation INVOS 5100C device. The impact that this extracranial contamination may have on the clinical use of these devices remains to be determined. RésuméObjectif Selon les études réalisées par le passé, la plupart des oxymètres cérébraux sont sujets à des inexactitudes suite à une contamination extracrânienne des signaux d'oxymétrie cérébrale. Nous avons émis l'hypothèse que l'oxymètre cérébral FORE-SIGHT ELITE, l'oxymètre cérébral de deuxième génération le plus innovant à ce jour, serait significativement moins affecté par l'hypoxémie des tissus extracrâniens que le moniteur de première génération INVOS TM 5100C, plus répandu.

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“…The first values recorded for the right and left hemisphere by cerebral oximetry were accepted as the preoperative baseline values. A decrease by 20% from the awakening baseline value was accepted as the threshold for intervention (9). Interventions included increasing the oxygen, normalizing hemodynamics and warning the surgeon.…”

Section: Methodsmentioning

confidence: 99%

Effects of Fentanyl with Levobupivacaine on Cognitive Functions and Cerebral Oxygenation

et al. 2013

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Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery

Cited by 550 publications

References 24 publications

Investigation of one-lung ventilation postoperative cognitive dysfunction and regional cerebral oxygen saturation relations

Investigation of one-lung ventilation postoperative cognitive dysfunction and regional cerebral oxygen saturation relations

Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers

Effects of Fentanyl with Levobupivacaine on Cognitive Functions and Cerebral Oxygenation

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