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CARDIOVASCULAR ANESTHESIA

The Effect of Diabetes on the Interrelationship Between Jugular Venous Oxygen Saturation Responsiveness to Phenylephrine Infusion and Cerebrovascular Carbon Dioxide Reactivity

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

Departments of *Intensive Care and Anesthesiology, Gunma University, Graduate School of Medicine; and Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center and Keiyu Orthopedic Hospital, Japan

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

In this study, we examined whether cerebrovascular carbon dioxide (CO₂) reactivity was related to the response of jugular venous oxygen saturation (SjvO₂) to phenylephrine infusion in diabetic patients during cardiopulmonary bypass. Forty diabetic patients scheduled for coronary artery bypass graft surgery were studied, and 40 age-matched nondiabetic cardiopulmonary bypass patients served as controls. Cerebrovascular CO₂ reactivity was measured continuously using transcranial Doppler. Mean arterial blood pressure (MAP) was increased by repeated phenylephrine infusion until reaching 100% of baseline values. There was a significant difference in absolute CO₂ reactivity between the diabetic and control groups (controls, 2.8 ± 0.7 cm · s^–1 · mm Hg^–1; diabetics, 2.2 ± 1.1 cm · s^–1 · mm Hg^–1; P = 0.02). Among the diabetics, absolute CO₂ reactivity in insulin-dependent patients was less than that in noninsulin-dependent patients (diet therapy group, 3.2 ± 0.7; glibenclamide group, 2.6 ± 0.7; insulin-dependent group, 1.0 ± 0.7; P < 0.01). There was a correlation between absolute CO₂ reactivity and the mean slope of SjvO₂ versus MAP for increasing MAP (r = 0.54; P < 0.0001). In conclusion, we found that the interrelationship between SjvO₂ responsiveness to phenylephrine infusion and cerebrovascular CO₂ reactivity, as well as impaired cerebrovascular autoregulation, were associated with previous hyperglycemia.

IMPLICATIONS: We examined whether the interrelationship between jugular venous oxygen saturation responsiveness to phenylephrine infusion and cerebrovascular CO₂ reactivity, as well as impaired cerebrovascular autoregulation, were associated with previous hyperglycemia.

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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