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 (5) Citing Articles via Google Scholar Google Scholar Articles by Kiziltan, H. T. Articles by Aslamaci, S. Search for Related Content PubMed PubMed Citation Articles by Kiziltan, H. T. Articles by Aslamaci, S. Related Collections Heart Monitoring (Cardiac) Monitoring (Non-cardiac)

---

CARDIOVASCULAR ANESTHESIA

Comparison of Alpha-Stat and pH-Stat Cardiopulmonary Bypass in Relation to Jugular Venous Oxygen Saturation and Cerebral Glucose-Oxygen Utilization

H. Tarik Kiziltan, MD^*, Mehmet Baltal, MD, Ahmet Bilen, MD, Gülah Seydaoglu, MD, Muzaffer Incesoz, BS^||, Atlay Tasdelen, MD^*, and Sait Aslamaci, MD^*

Departments of *Cardiothoracic Surgery, Cardiology, Anesthesiology, Preventive Medicine and Biostatistics, and ||Assisted Circulation, Baskent University, Adana Medical Center, Adana, Turkey

Address correspondence and reprint requests to H. Tarik Kiziltan, MD, Department of Cardiothoracic Surgery, Baskent University, Adana Medical Center, Adana, Turkey 01250. Address e-mail to tkiziltan{at}turk.net

Jugular venous oxygen saturation (SJVO₂) reflects the balance between cerebral blood flow and metabolism. This study was designed to compare the effects of two different acid-base strategies on jugular venous desaturation (SJVO₂ <50%) and cerebral arteriovenous oxygen-glucose use. We performed a prospective, randomized study in 52 patients undergoing cardiopulmonary bypass (CPB) at 27°C with either alpha-stat (n = 26) or pH-stat (n = 26) management. A retrograde internal jugular vein catheter was inserted, and blood samples were obtained at intervals during CPB. There were no differences in preoperative variables between the groups. SJVO₂ was significantly higher in the pH-stat group (at 30 min CPB: 86.2% ± 6.1% versus 70.6% ± 9.3%; P < 0.001). The differences in arteriovenous oxygen and glucose were smaller in the pH-stat group (at 30 min CPB: 1.9 ± 0.82 mL/dL versus 3.98 ± 1.12 mL/dL; P < 0.001; and 3.67 ± 2.8 mL/dL versus 10.1 ± 5.2 mL/dL; P < 0.001, respectively). All episodes of desaturation occurred during rewarming, and the difference in the incidence of desaturation between the two groups was not significant. All patients left the hospital in good condition. Compared with alpha-stat, the pH-stat strategy promotes an increase in SJVO₂ and a decrease in arteriovenous oxygen and arteriovenous glucose differences. These findings indicate an increased cerebral supply with pH-stat; however, this strategy does not eliminate jugular venous desaturation during CPB.

IMPLICATIONS: A prospective, randomized study in 52 patients during cardiopulmonary bypass revealed that pH-stat increased jugular venous oxygen saturation and decreased arteriovenous oxygen-glucose differences. There was no difference in the incidence of jugular venous desaturation. These findings suggest an increased cerebral blood flow with no protection against jugular venous desaturation during pH-stat.

This article has been cited by other articles:

				L. R. Hoover, R. Dinavahi, W.-P. Cheng, J. R. Cooper Jr, M. R. Marino, T. C. Spata, G. L. Daniels, W. K. Vaughn, and N. A. Nussmeier Jugular Venous Oxygenation During Hypothermic Cardiopulmonary Bypass in Patients at Risk for Abnormal Cerebral Autoregulation: Influence of {alpha}-Stat Versus pH-Stat Blood Gas Management Anesth. Analg., May 1, 2009; 108(5): 1389 - 1393. [Abstract] [Full Text] [PDF]

				C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg., July 1, 2006; 103(1): 21 - 37. [Abstract] [Full Text] [PDF]