MISC

2009年11月

Jugular bulb desaturation during off-pump coronary artery bypass surgery

JOURNAL OF ANESTHESIA
  • Norikazu Miura
  • ,
  • Kenji Yoshitani
  • ,
  • Masahiko Kawaguchi
  • ,
  • Masahide Shinzawa
  • ,
  • Tomoya Irie
  • ,
  • Osamu Uchida
  • ,
  • Yoshihiko Ohnishi
  • ,
  • G. Burkhard Mackensen

23
4
開始ページ
477
終了ページ
482
記述言語
英語
掲載種別
DOI
10.1007/s00540-009-0794-8
出版者・発行元
SPRINGER TOKYO

Purpose. Off-pump coronary artery bypass grafting surgery (OPCAB) frequently results in significant jugular bulb desaturation. Although jugular bulb desaturation during OPCAB may be associated with postoperative cerebral injury, routine jugular bulb oximetry appears to be invasive and expensive. We hypothesized that intraoperative hemodynamic compromise during OPCAB due to cardiac displacement is associated with jugular bulb desaturation which correlates with specific hemodynamic and physiological changes.
Methods. Hemodynamic and physiological data were measured at the following points: (1) before anastomosis of the coronary artery (baseline); (2) during anastomosis of the left anterior descending artery; (3) during anastomosis of the circumflex branch or posterior descending artery; and (4) after chest closure. Arterial, mixed venous, and jugular venous bulb blood gas analyses were performed serially.
Results. Jugular bulb desaturation (<= 50%) frequently occurred during surgical displacement of the heart. Mixed venous oxygen saturation (Sv(O2)), partial pressure of carbon dioxide (Pa(CO2)), and central venous pressure (CVP) showed a significant relationship with jugular bulb oxygen saturation (r = 0.45) by multivariate linear regression analysis. Multivariate logistic regression analysis also demonstrated that Sv(O2) <= 70%, Pa(CO2) <= 40 mmHg, and CVP >= 8 mmHg were likely predictors of the occurrence of jugular bulb desaturation.
Conclusion. Changes in Sv(O2) and Pa(CO2) were associated with jugular bulb oxygen saturation, and Sv(O2) = 70%, Pa(CO2) = 40 mmHg, and CVP = 8 mmHg had a significant odds ratio for jugular bulb desaturation. We suggest that achieving normal values of Sv(O2), Pa(CO2), and CVP may be important to prevent cerebral desaturation during OPCAB.

リンク情報
DOI
https://doi.org/10.1007/s00540-009-0794-8
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/19921353
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000271938000001&DestApp=WOS_CPL
URL
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=70450255122&origin=inward
ID情報
  • DOI : 10.1007/s00540-009-0794-8
  • ISSN : 0913-8668
  • PubMed ID : 19921353
  • SCOPUS ID : 70450255122
  • Web of Science ID : WOS:000271938000001

エクスポート
BibTeX RIS