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Detection of cerebral hypoperfusion during cardiopulmonary bypass
Author(s) -
ANDREWS P. J. D.,
COLQUHOUN A. D.
Publication year - 1994
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1994.tb04310.x
Subject(s) - medicine , cardiopulmonary bypass , anesthesia , perfusion , catheter , hypothermia , cardiology , surgery
Summary We measured continuously cerebral venous oxyhaemoglobin saturation (Sjvo 2 ) using a 4F fibreoptic catheter in 11 patients scheduled for elective myocardial revascularisation. The aims of this study were to assess the Oximetrix 3 computer and Opticath 40 cm catheter during moderate hypothermic cardiopulmonary bypass, and identify epochs of cerebral hypoperfusion (Sjvo 2 < 54%). Radial artery pressure, brain electrical activity, arterial and cerebral venous oximetry (dual oximetry), end‐tidal CO 2 and nasopharyngeal temperature were recorded continuously in each patient. Following in vivo calibration of 11 continuous Sjvo 2 catheters and monitor, 57 simultaneous, paired recordings were additionally taken. The mean difference between the catheter Sjvo 2 and the in vitro laboratory derived value was 0.34%, with a 95% confidence interval –3.2% to 2.4%. In 10 patients Sjvo 2 decreased below normal at rewarming and myocardial reperfusion: mean lowest value 37%, range 19%–55%. Reduced Sjvo 2 were associated with a decrease in perfusion pressure (r = 0.292, 80 DF, p = 7.7* 10 ‐3 ), and with an increase in nasopharyngeal temperature (r =–0.46, 115 DF, p = 2.7* 10 ‐7 ) after moderate hypothermia. The Oximetrix 3 computer and Opticath 40cm catheter provided reliable and accurate continuous monitoring of Sjvo 2 during nonpulsatile cardiopulmonary bypass involving hypothermia with haemodilution and identified rewarming as the period of greatest risk of global cerebral hypoperfusion.