Monitoring brain oxygen saturation during awake off-pump coronary artery bypass

Abstract

Objective: To evaluate the changes in cerebral blood flow during awake off-pump coronary artery bypass grafting and compare with the changes during off-pump coronary artery bypass grafting under general anesthesia, using continuous monitoring of regional cerebral oxygen saturation.Methods: The study population comprised 3 groups of patients who had undergone off-pump coronary artery bypass grafting with thoracic epidural anesthesia, general anesthesia, or a combination of the two. Regional brain oxygen saturation, determined with a near-infrared oxygen monitor, and mean arterial pressure during surgery were calculated and compared among the 3 groups.Results: Patients who had undergone awake off-pump coronary artery bypass grafting with thoracic epidural anesthesia had a significantly higher cerebrovascular impairment ratio, and the EuroSCORE was high. No significant differences were observed among the 3 groups in terms of the relationship between mean arterial pressure during surgery and regional brain oxygen saturation. It is suggested that there were no differences in cerebral blood flow and mean arterial pressure changes among the 3 groups.Conclusions: Awake off-pump coronary artery bypass grafting is a safe surgical technique for patients with history of cerebral infarction or impaired cerebral blood flow. Awake off-pump coronary artery bypass grafting is a less invasive procedure that allows efficient management of intraoperative cerebral blood flow, and can be equally effective as a percutaneous coronary intervention.

On- or Off-Pump Coronary Artery Bypass: What Is the Evidence?

“…In addition, distortion of the mitral annulus and ischemia-reperfusion injury can cause significant mitral regurgitation. It has been advocated that continued cardiac output, mixed venous saturation of oxygen (SvO2), and brain oxygen saturation monitoring should be routine practiced for OPCAB (41,43). One claimed advantage of OPCAB is a lower incident of neurological deficit, which may be associated with limited maneuver/cross clamping on the athermanous aorta.…”