JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Murkin, J. M. Articles by Fox, S. Search for Related Content PubMed PubMed Citation Articles by Murkin, J. M. Articles by Fox, S. Related Collections Cardiovascular Outcomes Monitoring (Non-cardiac) Technology

---

CARDIOVASCULAR ANESTHESIA

Monitoring Brain Oxygen Saturation During Coronary Bypass Surgery: A Randomized, Prospective Study

John M. Murkin, MD, FRCPC^*, Sandra J. Adams, RN^*, Richard J. Novick, MD, FRCSC, Mackenzie Quantz, MD, FRCPS, Daniel Bainbridge, MD, FRCPC^*, Ivan Iglesias, MD^*, Andrew Cleland, RRT, Betsy Schaefer, BSc^*, Beverly Irwin, RN^*, and Stephanie Fox, RRT

From the *Department of Anesthesiology and Perioperative Medicine; Clinical Perfusion Services; and Division of Cardiac Surgery, University Hospital-LHSC, University of Western Ontario, London, Ontario, Canada.

Address correspondence and reprint requests to Dr. J. Murkin, Rm C3-112, University Hospital Campus LHSC, 339 Windermere Rd, London, Ontario, Canada N6A 5A5. Address e-mail to jmurkin{at}uwo.ca.

BACKGROUND: Cerebral deoxygenation is associated with various adverse systemic outcomes. We hypothesized, by using the brain as an index organ, that interventions to improve cerebral oxygenation would have systemic benefits in cardiac surgical patients.

METHODS: Two-hundred coronary artery bypass patients were randomized to either intraoperative cerebral regional oxygen saturation (rSO₂) monitoring with active display and treatment intervention protocol (intervention, n = 100), or underwent blinded rSO₂ monitoring (control, n = 100). Predefined clinical outcomes were assessed by a blinded observer.

RESULTS: Significantly more patients in the control group demonstrated prolonged cerebral desaturation (P = 0.014) and longer duration in the intensive care unit (P = 0.029) versus intervention patients. There was no difference in overall incidence of adverse complications, but significantly more control patients had major organ morbidity or mortality (death, ventilation >48 h, stroke, myocardial infarction, return for re-exploration) versus intervention group patients (P = 0.048). Patients experiencing major organ morbidity or mortality had lower baseline and mean rSO₂, more cerebral desaturations and longer lengths of stay in the intensive care unit and postoperative hospitalization, than patients without such complications. There was a significant (r² = 0.29) inverse correlation between intraoperative rSO₂ and duration of postoperative hospitalization in patients requiring 10 days postoperative length of stay.

CONCLUSION: Monitoring cerebral rSO₂ in coronary artery bypass patients avoids profound cerebral desaturation and is associated with significantly fewer incidences of major organ dysfunction.

This article has been cited by other articles:

				M. S. Shuler, W. M. Reisman, T. E. Whitesides Jr., T. L. Kinsey, E. M. Hammerberg, M. G. Davila, and T. J. Moore Near-Infrared Spectroscopy in Lower Extremity Trauma J. Bone Joint Surg. Am., June 1, 2009; 91(6): 1360 - 1368. [Abstract] [Full Text] [PDF]

				M. Smith and C. Elwell Near-Infrared Spectroscopy: Shedding Light on the Injured Brain Anesth. Analg., April 1, 2009; 108(4): 1055 - 1057. [Full Text] [PDF]

				B. D. Kussman, D. Wypij, J. A. DiNardo, J. W. Newburger, J. E. Mayer Jr, P. J. del Nido, E. A. Bacha, F. Pigula, E. McGrath, P. C. Laussen, et al. Cerebral Oximetry During Infant Cardiac Surgery: Evaluation and Relationship to Early Postoperative Outcome Anesth. Analg., April 1, 2009; 108(4): 1122 - 1131. [Abstract] [Full Text] [PDF]

				J. P. Slater, T. Guarino, J. Stack, K. Vinod, R. T. Bustami, J. M. Brown III, A. L. Rodriguez, C. J. Magovern, T. Zaubler, K. Freundlich, et al. Cerebral Oxygen Desaturation Predicts Cognitive Decline and Longer Hospital Stay After Cardiac Surgery Ann. Thorac. Surg., January 1, 2009; 87(1): 36 - 45. [Abstract] [Full Text] [PDF]

				J. D. Tobias Cerebral Oximetry Monitoring with Near Infrared Spectroscopy Detects Alterations in Oxygenation Before Pulse Oximetry J Intensive Care Med, November 1, 2008; 23(6): 384 - 388. [Abstract] [PDF]

				G. M. T. Hare, A. K. Y. Tsui, A. T. McLaren, T. E. Ragoonanan, J. Yu, and C. D. Mazer Anemia and Cerebral Outcomes: Many Questions, Fewer Answers Anesth. Analg., October 1, 2008; 107(4): 1356 - 1370. [Abstract] [Full Text] [PDF]

				K. C. Santo, A. Barrios, U. Dandekar, P. Riley, P. Guest, and R. S. Bonser Near-Infrared Spectroscopy: An Important Monitoring Tool During Hybrid Aortic Arch Replacement Anesth. Analg., September 1, 2008; 107(3): 793 - 796. [Abstract] [Full Text] [PDF]

				S. W. Hong, J. K. Shim, Y. S. Choi, D. H. Kim, B. C. Chang, and Y. L. Kwak Prediction of cognitive dysfunction and patients' outcome following valvular heart surgery and the role of cerebral oximetry Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 560 - 565. [Abstract] [Full Text] [PDF]

				G. W. Fischer Recent Advances in Application of Cerebral Oximetry in Adult Cardiovascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2008; 12(1): 60 - 69. [Abstract] [PDF]

				P. Meybohm, G. Hoffmann, J. Renner, A. Boening, E. Cavus, M. Steinfath, J. Scholz, and B. Bein Measurement of Blood Flow Index During Antegrade Selective Cerebral Perfusion with Near-Infrared Spectroscopy in Newborn Piglets Anesth. Analg., March 1, 2008; 106(3): 795 - 803. [Abstract] [Full Text] [PDF]

				A. Denault, A. Deschamps, and J. M. Murkin A Proposed Algorithm for the Intraoperative Use of Cerebral Near-Infrared Spectroscopy Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 274 - 281. [Abstract] [PDF]

				J. M. Murkin Cerebral Autoregulation: The Role of CO2 in Metabolic Homeostasis Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 269 - 273. [Abstract] [PDF]

				G. M. T. Hare, C. D. Mazer, J. S. Hutchison, A. T. McLaren, E. Liu, A. Rassouli, J. Ai, R. E. Shaye, J. A. Lockwood, C. E. Hawkins, et al. Severe hemodilutional anemia increases cerebral tissue injury following acute neurotrauma J Appl Physiol, September 1, 2007; 103(3): 1021 - 1029. [Abstract] [Full Text] [PDF]

				H. B. Nielsen and J. Borglum Cerebral Oxygenation in Heart Surgery Anesth. Analg., August 1, 2007; 105(2): 537 - 537. [Full Text] [PDF]

				J. M. Murkin, D. Bainbridge, and R. Novick Adequacy of Brain Oxygen Saturation for Goal-Directed Therapy Anesth. Analg., August 1, 2007; 105(2): 538 - 539. [Full Text] [PDF]

				E. C. Nemergut and W. J. Mauermann Do the Data Really Support the Conclusion? Anesth. Analg., August 1, 2007; 105(2): 536 - 537. [Full Text] [PDF]

				M. Dworschak Adequacy of Brain Oxygen Saturation for Goal-Directed Therapy Anesth. Analg., August 1, 2007; 105(2): 537 - 538. [Full Text] [PDF]

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