Anesth Analg 2000;91:1317-1326
© 2000 International Anesthesia Research Society
CARDIOVASCULAR ANESTHESIA
Cognition After Coronary Artery Surgery Is Not Related to Postoperative Jugular Bulb Oxyhemoglobin Desaturation
Michael J. A. Robson, MB ChB, FRCA*, ,
R. Peter Alston, MD, FRCA*, ,
Ian J. Deary, PhD, FRCPE ,
Peter J. D. Andrews, MD, FRCA*,§,
Michael J. Souter, MB ChB, FRCA||, and
Shona Yates, BSc. (Hons.)
Departments of
*Clinical and Surgical Sciences (Anaesthetics) and
Psychology, University of Edinburgh; Departments of Anaesthetics,
Royal Infirmary of Edinburgh and
§Western General Hospital Edinburgh; and
||Department of Neuroanaesthesia, Southern General Hospital, Glasgow, Scotland
Address correspondence and reprint requests to M. J. A. Robson, MB, ChB, FRCA, Department of Anaesthetics, Royal Infirmary of Edinburgh, 1 Lauriston Pl., Edinburgh, EH3 9YW, Scotland, UK. Address e-mail to mrobson{at}ed.ac.uk
During the early postoperative period after coronary artery bypass grafting (CABG) surgery, many patients experience jugular bulb oxyhemoglobin desaturation (SjO2 < 50%). We sought to determine whether SjO2 during cardiopulmonary bypass and the early postoperative period influenced long-term cognitive performance after CABG surgery. One hundred two patients completed a battery of cognitive tests the day before and 3 mo after CABG surgery. A General Cognitive Score was generated from these tests as an overall measure of cognitive function. Intraoperatively, SjO2 was determined by intermittent blood sampling, and postoperatively, the area under the curve of SjO2 < 50% and time was calculated from continuous reflectance oximetry. No significant correlations between cognitive performance and either intra- or postoperative SjO2 were found. Preoperative cognitive performance was the main determinant of cognition at 3 mo (r2 = 0.83, P < 0.001), and palpable atheroma of the ascending aorta made a small, but significant, contribution to a decline in cognition (r2 = 0.018, P = 0.001).
Implications: Postoperative cerebral hypoperfusion, indicated by oxyhemoglobin desaturation < 50%, occurs in many patients after coronary artery bypass graft surgery. However, this measurement of hypoperfusion does not appear to influence long-term cognition after coronary artery bypass graft surgery.
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