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Anesth Analg 2006;102:1609-1616
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000219589.03633.BF

CARDIOVASCULAR ANESTHESIA

The Marked Reduction in Mixed Venous Oxygen Saturation During Early Mobilization After Cardiac Surgery: The Effect of Posture or Exercise?

Idar Kirkeby-Garstad, MD, Ulrik Wisløff, PhD, Eirik Skogvoll, MD, PhD, Tomas Stølen, Arnt-Erik Tjønna, Roar Stenseth, MD, PhD, and Olav FM Sellevold, MD, PhD

Department of Cardiothoracic Anesthesia and Intensive Care, St Olav University Hospital, Department of Circulation and Medical Imaging, and Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Address correspondence and reprint requests to Idar Kirkeby-Garstad, MD, Department of Cardiothoracic Anesthesia and Intensive Care, St. Olav University Hospital Hans Nissens gt 3, N 7018 Trondheim, Norway. Address e-mail to Idar.Kirkeby-Garstad{at}ntnu.no.

Early mobilization after cardiac surgery induces a marked reduction in mixed venous oxygen saturation (Svo2). Using pulmonary artery catheters and indirect calorimetry, we investigated the effects of exercise and postural change on cardiac index (CI) and Svo2 before and on the first morning after coronary artery bypass surgery. Sixteen patients with an ejection fraction >0.50 were studied at rest, during supine bicycle exercise, and during passive standing. Supine cycling at 30 W increased CI by 1.5 ± 0.8 L · min–1 · m–2 before and 0.9 ± 0.7 L · min–1 · m–2 after surgery (P < 0.05), whereas Svo2 was reduced from 80% ± 4% at rest to 63 ± 6% preoperatively (P < 0.05) and from 71% ± 5% to 46% ± 11% postoperatively (P < 0.05). Passive standing reduced CI by 0.8 ± 0.5 L · min–1 · m–2 before and 0.3 ± 0.4 L · min–1 · m–2 after surgery (P < 0.05). Svo2 was reduced from 79% ± 5% to 64% ± 7% preoperatively (P < 0.05) and from 72% ± 6% to 60% ± 6% postoperatively (P < 0.05). The exercise challenge revealed an altered cardiovascular response after surgery, causing a larger reduction in Svo2 for the same workload. Passive standing significantly reduced Svo2 both days, but this effect was less pronounced after surgery. The response to postural change and exercise was altered after surgery and may both contribute to the reduction in Svo2 during postoperative mobilization.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.