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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.

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