This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Kadoi, Y. Articles by Fujita, N. Search for Related Content PubMed PubMed Citation Articles by Kadoi, Y. Articles by Fujita, N. Related Collections Cardiovascular Postanesthetic Care Unit Monitoring (Non-cardiac)

---

CARDIOVASCULAR ANESTHESIA

Slow Rewarming Has No Effects on the Decrease in Jugular Venous Oxygen Hemoglobin Saturation and Long-Term Cognitive Outcome in Diabetic Patients

Yuji Kadoi, MD^*, Shigeru Saito, MD^*, Fumio Goto, MD^*, and Nao Fujita, MD

*Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine; and Department of Anesthesiology, Keiyu Orthopedic Hospital, Gunma, Japan

Address correspondence and reprint requests to Yuji Kadoi, MD, Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. Address e-mail to kadoi{at}med.gunma-u.ac.jp

The purpose of this study was to examine the effects of rewarming rate on internal jugular venous oxygen hemoglobin saturation (SjvO₂) during the rewarming period, and long-term cognitive outcome in diabetic patients. We studied 30 diabetic patients scheduled for elective coronary artery bypass graft surgery. As a control, 30 age-matched nondiabetic patients were identified. The diabetic patients were randomly divided into two groups: the Slow Rewarming group (n = 15) (mean rewarming speed: 0.22° ± 0.07°C/min, mean ± SD) or the Standard Rewarming group (Standard group) (n = 15) (mean rewarming speed: 0.46° ± 0.09°C/min, mean ± SD). After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO₂ continuously. Hemodynamic variables and arterial and jugular venous blood gases were measured at nine time points. All patients underwent a battery of neurologic and neuropsychologic tests on the day before the operation and at 4 mo after surgery. The SjvO₂ values in the Standard group were decreased during the rewarming period compared with at the induction of anesthesia (P < 0.05). There was a significant difference in the SjvO₂ value in the Control group between standard rewarming and slow rewarming during rewarming periods (Standard Control group: 51% ± 8%, Slow Control groups: 58% ± 5%) (P < 0.05). However, there was no difference in the SjvO₂ value in diabetic patients between standard rewarming and slow rewarming during the rewarming period. The rewarming rates (odds ratio: 0.8; 95% confidence interval: 0.5–1.3; P = 0.6) had no correlation with cognitive impairment at 4 mo after the surgery. Diabetes (odds ratio: 1.6; 95% confidence interval: 0.9–2.6; P = 0.04) was a factor in relation to cognitive impairment at 4 mo after the surgery. We concluded that a slow rewarming rate had no effects on the reduction in SjvO₂ value and long-term cognitive outcome in diabetic patients.

IMPLICATIONS: We examined the effects of rewarming rate on internal jugular venous oxygen hemoglobin saturation in diabetic and nondiabetic patients during the rewarming period and long-term cognitive outcome. Slow rewarming could not prevent the frequency of the reduction in internal jugular venous oxygen hemoglobin saturation and adverse cognitive outcome in diabetic patients.

This article has been cited by other articles:

				Y. Kadoi, K.-i. Takahashi, S. Saito, and F. Goto The comparative effects of sevoflurane versus isoflurane on cerebrovascular carbon dioxide reactivity in patients with diabetes mellitus. Anesth. Analg., July 1, 2006; 103(1): 168 - 172. [Abstract] [Full Text] [PDF]

				Y. Kadoi, S. Saito, N. Fujita, and F. Goto Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 576 - 583. [Abstract] [Full Text] [PDF]

				Y. Kadoi, S. Saito, F. Goto, and N. Fujita The Effect of Diabetes on the Interrelationship Between Jugular Venous Oxygen Saturation Responsiveness to Phenylephrine Infusion and Cerebrovascular Carbon Dioxide Reactivity Anesth. Analg., August 1, 2004; 99(2): 325 - 331. [Abstract] [Full Text] [PDF]

				Y. Kadoi, S. Saito, F. Kunimoto, F. Goto, and N. Fujita Comparative effects of propofol versus fentanyl on cerebral oxygenation state during normothermic cardiopulmonary bypass and postoperative cognitive dysfunction Ann. Thorac. Surg., March 1, 2003; 75(3): 840 - 846. [Abstract] [Full Text] [PDF]

				R. P. Alston and Y. Kadoi Rewarming Rate, Diabetes, Jugular Bulb Saturation, and Cognitive Outcome from CABG Surgery * Response Anesth. Analg., March 1, 2003; 96(3): 914 - 915. [Full Text] [PDF]