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CARDIOVASCULAR ANESTHESIA

Increasing Mean Arterial Blood Pressure Has No Effect on Jugular Venous Oxygen Saturation in Insulin-Dependent Patients During Tepid Cardiopulmonary Bypass

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

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

Address correspondence and reprint requests to Yuji Kadoi, 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

Preexisting diabetes mellitus is one of the major factors related to adverse postoperative neurological disorders after cardiac surgery. In previous reports, we found that diabetic patients more often experienced cerebral desaturation than nondiabetic patients during normothermic cardiopulmonary bypass (CPB). The purpose of this study was to examine the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen hemoglobin saturation (SjvO₂) during tepid CPB in diabetic patients. We studied 20 diabetic patients scheduled for elective coronary artery bypass graft surgery and, as a control, 20 age-matched nondiabetic patients. After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO₂. After measuring the baseline partial pressure of the arterial and jugular venous blood gases and cardiovascular hemodynamic values, MAP was increased by the repeated administration of a 10-µg bolus of phenylephrine until it reached 100% of baseline values. There was a significant difference in SjvO₂ value between the Diabetic and Control groups after the administration of phenylephrine (Diabetic group, 56% ± 6%; Control group: 60% ± 4%) (P < 0.05). There was a significant difference in the arterial-jugular oxygen content difference value between the Diabetic and Control groups after the administration of phenylephrine (diabetic group, 4.9% ± 0.6%; Control group, 4.5% ± 0.4%) (P < 0.05). We subdivided the Diabetic group into three groups (Diet Therapy group [n = 4], Glibenclamide group [n = 10], and Insulin-Dependent group [n = 6]). There was a significant difference in the mean slopes of SjvO₂ versus cerebral perfusion pressure for increasing cerebral perfusion pressure between the Insulin-Dependent group and the other groups (Dunnett test: P = 0.04). Increasing MAP had no effects on the SjvO₂ value in insulin-dependent patients during tepid CPB.

IMPLICATIONS: We examined the effects of increasing mean arterial blood pressure (MAP) by the administration of phenylephrine on internal jugular venous oxygen saturation (SjvO₂) during tepid cardiopulmonary bypass in diabetic patients and found that increasing MAP had no effect on the SjvO₂ value in insulin-dependent patients.

This article has been cited by other articles:

				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, H. Hinohara, F. Kunimoto, S. Saito, M. Ide, H. Hiraoka, F. Kawahara, and F. Goto Diabetic Patients Have an Impaired Cerebral Vasodilatory Response to Hypercapnia Under Propofol Anesthesia Stroke, October 1, 2003; 34(10): 2399 - 2403. [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]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999