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Anesth Analg 2009; 108:1389-1393
© 2009 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318187c39d
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CARDIOVASCULAR ANESTHESIOLOGY

Jugular Venous Oxygenation During Hypothermic Cardiopulmonary Bypass in Patients at Risk for Abnormal Cerebral Autoregulation: Influence of {alpha}-Stat Versus pH-Stat Blood Gas Management

Lance R. Hoover, MD*, Radhika Dinavahi, MD{dagger}, Wei-Ping Cheng, MD{ddagger}, John R. Cooper, Jr, MD{dagger}§, Maria Rosa Marino, MD||, Tyler C. Spata, BA{dagger}, Gaile L. Daniels, EMT{dagger}, William K. Vaughn, PhD, and Nancy A. Nussmeier, MD#

From the *Department of Cardiothoracic Anesthesia, San Antonio Uniform Health Education Consortium, San Antonio, Texas; {dagger}Division of Cardiovascular Anesthesiology, the Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas; {ddagger}Department of Anesthesiology, The Cardiovascular Institute and Fu Wai Hospital at the Chinese Academy of Medical Sciences, Beijing; §Department of Anesthesiology, Baylor College of Medicine, Houston, Texas; ||Department of Cardiovascular Anaesthesia, Centro Cardiologico Monzino IRCCS, Milano, Italy; ¶Department of Biostatistics and Epidemiology, the Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas; and #Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, New York.

Address correspondence and reprint requests to Dr. Nancy A. Nussmeier, Department of Anesthesiology, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210. Address e-mail to nussmein{at}upstate.edu.

Abstract

In a prospective, randomized study of cardiac surgical patients at risk for impaired cerebral blood flow autoregulation, we compared {alpha}-stat and pH-stat blood gas management. The 40 patients enrolled had age >70 yr, diabetes, prior stroke, or uncontrolled hypertension. During hypothermia and early rewarming, jugular oxygen tensions were significantly lower in {alpha}-stat patients (n = 12) than pH-stat patients (n = 19; P < 0.05). During rewarming, jugular venous desaturation (i.e., SjvO2 <50%) occurred in 6 of 12 {alpha}-stat patients, but no pH-stat patients (P = 0.0006). Patients at risk for poor cerebral autoregulation have higher oxygen tensions and saturations if pH-stat blood gas management is used during cardiopulmonary bypass.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2009 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2009 by the International Anesthesia Research Society.