Document Detail


Using jugular bulb oxyhemoglobin saturation to guide onset of deep hypothermic circulatory arrest does not affect post-operative neuropsychological function.
MedLine Citation:
PMID:  15019667     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Deep hypothermic circulatory arrest (DHCA) is commonly used during thoracic aortic surgery, and is initiated only after a sufficient degree of cerebral hypothermia is induced. The criteria for initiating DHCA vary among institutions: most centers use temperature criteria, some use electroencephalography, and a minority use jugular bulb oxyhemoglobin saturation SjO(2) criteria. The purpose of this study was to determine whether the use of SjO(2) monitoring to guide the onset of DHCA was associated with better post-operative neuropsychological outcome. METHODS: Sixty-one thoracic aortic surgical patients underwent both pre- and post-operative neuropsychological testing. Patients were divided into three groups: (1) those with SjO(2)> or =95% at DHCA onset; (2) those with SjO(2)<95% at DHCA onset; and (3) those without SjO(2) monitoring. RESULTS: There were no statistically significant differences in the incidence of post-operative decline in neuropsychological function among the three groups of patients. Patients in whom SjO(2) data were used to guide onset of DHCA had lower esophageal and bladder temperatures at that time compared with patients without SjO(2) monitoring. CONCLUSIONS: Monitoring of SjO(2) had no apparent effect upon post-operative neuropsychological outcome, and there were no trends in our small patient cohort suggesting differences that our study was not adequately powered to detect. Use of SjO(2) monitoring was associated with more profound hypothermia prior to DHCA due to more prolonged cooling in attempts to bring the SjO(2) above the 95% threshold. Using our institutional cooling protocol, SjO(2) monitoring does not appear to increase neuroprotection in patients undergoing DHCA for thoracic aortic repairs.
Authors:
David L Reich; Loren M Horn; Sabera Hossain; Suzan Uysal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  25     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-15     Completed Date:  2004-04-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  401-6; discussion 406-8     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA. david.reich@msnyuhealth.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Thoracic / blood,  surgery*
Attention / physiology
Cardiopulmonary Bypass / methods
Female
Heart Arrest, Induced / methods*
Humans
Hypothermia, Induced / methods
Male
Mental Disorders / etiology*,  physiopathology
Mental Processes / physiology
Middle Aged
Nervous System Diseases / etiology*,  physiopathology
Neuropsychological Tests
Oxyhemoglobins / analysis*
Postoperative Care
Postoperative Complications / psychology*
Psychomotor Performance / physiology
Chemical
Reg. No./Substance:
0/Oxyhemoglobins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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