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CARDIOVASCULAR ANESTHESIA

Jugular Bulb Oxyhemoglobin Desaturation, S100ß, and Neurologic and Cognitive Outcomes After Coronary Artery Surgery

Michael J. A. Robson, MB ChB, FRCA^*, R. Peter Alston, MD FRCA, Ian J. Deary, PhD FRCPE, Peter J. D. Andrews, MD FRCA^||, and Michael J. Souter, MB ChB, FRCA^¶

*Department of Anaesthesia, St. Vincent’s Hospital, Melbourne, Australia; Anaesthesia, Critical Care and Pain Medicine Section, Department of Clinical and Surgical Sciences, University of Edinburgh; Department of Anaesthesia, Royal Infirmary of Edinburgh, Scotland; Department of Psychology, University of Edinburgh, Scotland; ||Department of Anaesthesia, Western General Hospital, Edinburgh, Scotland; and ¶Department of Neuroanaesthesia, Southern General Hospital, Glasgow, Scotland

Address correspondence and reprint requests to M. J. A. Robson, Department of Anaesthesia, St. Vincent’s Hospital, Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia. Address e-mail to mjarobson{at}hotmail.com

We reported that a decline in cognitive performance 3 mo after coronary artery bypass grafting surgery is associated with palpable aortic atheroma, but not postoperative jugular bulb oxyhemoglobin saturation (SjO₂) <50%. However, the effect of SjO₂ on clinical neurologic findings is not known. S100ß is a possible surrogate biochemical marker of brain injury, and we report here the scored clinical neurologic findings in 98 patients from our previous study in relation to SjO₂, cognitive performance, aortic atheroma, and S100ß. Patients underwent a scored neurologic examination and cognitive assessment the day before and 3 mo after coronary artery bypass grafting surgery. Intraoperatively, intermittent blood sampling was performed, and postoperatively, the area under the curve describing SjO₂ <50% in relation to time was calculated from continuous jugular bulb reflectance oximetry. Palpation was used to assess the ascending aorta for the presence of atheroma. The jugular bulb concentration of S100ß was measured 6 h after completion of surgery. The neurologic score 3 mo after surgery did not correlate with either intra- or postoperative SjO₂ (r = 0.111, P = 0.278; and r = -0.074, P = 0.467, respectively). The main determinant of neurologic score at 3 mo was the preoperative neurologic score (r² = 0.63, P < 0.001), whereas palpable atheroma of the ascending aorta made a small but significant contribution (r² = 0.034, P = 0.004). Neurologic and cognitive scores correlated before surgery (r = 0.226, P = 0.022) and at 3 mo after surgery (r = 0.348, P < 0.001). A preoperative neurologic deficit of two or more had a small but significant negative effect on cognitive performance at 3 mo (standardized ß = -0.097, P = 0.018). There was a significant univariate correlation between S100ß and the 3-mo neurologic score (r = -0.232, P < 0.05), but not a multivariate correlation (ß = -0.090, P = 0.156).

IMPLICATIONS: Intraoperative jugular bulb oxyhemoglobin saturation (SjO₂) and postoperative SjO₂ <50% do not have an important influence on long-term neurologic outcome after coronary artery bypass graft surgery. Subtle preoperative neurology is associated with long-term cognitive decline, and aortic atheroma is a risk factor for both cognitive and neurologic decline.

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