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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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