Cognition After Coronary Artery Surgery Is Not Related to Postoperative Jugular Bulb Oxyhemoglobin Desaturation

Abstract

During the early postoperative period after coronary artery bypass grafting (CABG) surgery, many patients experience jugular bulb oxyhemoglobin desaturation (SjO(2) < 50%). We sought to determine whether SjO(2) during cardiopulmonary bypass and the early postoperative period influenced long-term cognitive performance after CABG surgery. One hundred two patients completed a battery of cognitive tests the day before and 3 mo after CABG surgery. A General Cognitive Score was generated from these tests as an overall measure of cognitive function. Intraoperatively, SjO(2) was determined by intermittent blood sampling, and postoperatively, the area under the curve of SjO(2) < 50% and time was calculated from continuous reflectance oximetry. No significant correlations between cognitive performance and either intra- or postoperative SjO(2) were found. Preoperative cognitive performance was the main determinant of cognition at 3 mo (r(2) = 0.83, P<0.001), and palpable atheroma of the ascending aorta made a small, but significant, contribution to a decline in cognition (r(2) = 0.018, P = 0.001).

Using jugular bulb oxyhemoglobin saturation to guide onset of deep hypothermic circulatory arrest does not affect post-operative neuropsychological function

“…All functional domains were affected; there was no selective impairment. Robson et al [10] found no relationship between intraoperative and post-operative episodes of desaturation and post-operative cognitive decline measured 3 months after surgery using a battery of 11 tests. In contrast, Yoshitani et al [11] found that high SjO 2 levels 10 min after start of surgery and at 30 8C during rewarming predicted cognitive decline 10 -14 days following cardiac surgery with hypothermic CPB using a brief mental status test and a test of visual memory.…”

Jugular Venous Oxygen Saturation During Mild Hypothermic Versus Normothermic Cardiopulmonary Bypass in Elderly Patients

“…Thus, further studies are necessary to determine if amelioration of the SjvO 2 value is associated with postoperative neurological dysfunction. Robson et al 20 provided evidence that jugular bulb catheters were not very accurate during bypass, possibly due to increased vessel wall contact; however, in a previous study, 22 we assessed the accuracy of our oximetric catheter system and found an excellent correlation between oximetry catheter values for SjvO 2 and simultaneous SjvO 2 values obtained from samples of jugular venous blood measured in a CO-oximeter. In conclusion, we observed decreased SjvO 2 values in the early phase of CPB more often in normothermic CPB than in hypothermic CPB in elderly patients.…”

“…We did not find any difference in the incidence of postoperative neurological dysfunction between our two groups, and it is unclear whether the SjvO 2 value was associated with the improvement of postoperative neurological dysfunction. 20 Robson et al 20 found average SjvO 2 values during hypothermic CPB, and in the early postoperative phase, but this was not associated with cognitive status 3 months after surgery performed under normothermic CPB. In contrast, Yoshitani et al 21 reported that a high SjvO 2 was associated with cognitive dysfunction after the operation.…”

Disfunción cognitiva después de cirugía cardiaca: Saturación cerebral e índice biespectral: estudio longitudinal

“…El nivel educacional e intelectual también fue similar entre los grupos. Entre las pruebas neurocognitivas basales, sólo la puntuación del test Aprendizaje Verbal Auditivo de Rey (RAVLT; evalúa memoria de fi jación y aprendizaje reciente, susceptibilidad a la interferencia, memoria a medio plazo y benefi cio del reconocimiento [38][39][40] ) fue diferente entre ambos grupos, siendo más alta en el grupo que presentó DCPO (P = 0,028, Mann-Whitney U-test, Tabla 2). Las características perioperatorias también fueron similares entre ambos grupos, al igual que los tiempos de extubación y de estancias hospitalaria y UCI (Tabla 3).…”

“…Evalúan la coordinación visuo-manual y fl exibilidad cognitiva, memoria declarativa [38][39][40] , inteligencia y lenguaje.…”