Elsevier

The Annals of Thoracic Surgery

Volume 58, Issue 6, December 1994, Pages 1702-1708
The Annals of Thoracic Surgery

Original article
Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass

https://doi.org/10.1016/0003-4975(94)91666-7Get rights and content

Abstract

Inadequate cerebral oxygenation during cardiopulmonary bypass may lead to postoperative cognitive dysfunction in patients undergoing cardiac operations. A psychological test battery was administered to 255 patients before cardiac operation and just before hospital discharge. Postoperative impairment was defined as a decline of more than one standard deviation in 20% of tests. Variables significantly (p < 0.05) associated with postoperative cognitive impairment are baseline psychometric scores, largest arterial-venous oxygen difference, and years of education. Jugular bulb hemoglobin saturation is significant if it replaces arterial-venous oxygen difference in the model. Factors correlated with jugular bulb saturation at normothermia were cerebral metabolic rate of oxygen consumption (r = -0.6; p < 0.0005), cerebr al blood flow (t = 0.4; p < 0.0,105), oxygen delivery (r = 0.4; p < 0.0005), and mean arterial pressure (r = 0.15; p < 0.05). Three measures were significantly related to desaturation at normothermia and at hypothermia as well: greater cerebral oxygen extraction, greater arterial-venous oxygen difference, and lower ratio of cerebral blood flow to arterial-venous oxygen difference. We conclude that cerebral venous desaturation occurs during cardiopulmonary bypass in 17% to 23% of people and is associated with impaired postoperative cognitive test performance.

References (22)

  • AL Benton et al.

    Multilingual aphasia examination

    (1976)
  • Cited by (218)

    • Neuromonitoring and Neurocognitive Outcomes in Cardiac Surgery: A Narrative Review

      2022, Journal of Cardiothoracic and Vascular Anesthesia
      Citation Excerpt :

      In contrast, there is an evolving body of evidence, first observational, and then from three randomized, prospective studies, that has shown an association between intraoperative cerebral desaturation and POCD.42-44,66,67 Observational evidence supports an AUC for desaturation <40% as the key predictor for POCD.66,82-85 Furthermore, prospective RCT data from patients (n = 265) undergoing on-pump CABG showed no significant incidence of POCD without desaturation <50%, and reinforced that desaturation load was associated with significant increased incidence of early POCD.67

    • Brain Tissue Oxygenation

      2018, Neuromonitoring Techniques: Quick Guide for Clinicians and Residents
    • Jugular Venous Oximetry

      2018, Neuromonitoring Techniques: Quick Guide for Clinicians and Residents
    View all citing articles on Scopus

    This research was supported in part by grant RO1-AG09663 from the National Institutes of Health.

    View full text