The Association of High Jugular Bulb Venous Oxygen Saturation with Cognitive Decline After Hypothermic Cardiopulmonary Bypass

Unlabelled BACKGROUND. The rewarming period of hypothermic cardiopulmonary bypass (CPB) is associated with reduced jugular bulb venous oxygen saturation (SjO2). This study investigates the effects of normocapnia vs. hypercapnia on changes in SjO2 during rewarming from hypothermic CPB for coronary artery bypass graft in patients classified as American Society of Anesthesiologists physical status 111. Methods Anesthesia was induced and maintained with fentanyl, midazolam, and continuous infusion of etomidate. Hypothermic CPB (27 degrees C) was managed according to alpha-stat conditions. The SjO2 percentage was measured using a fiberoptic catheter placed in the right jugular bulb via the right internal jugular vein. Data were recorded before and during the rewarming period. Patients were assigned to a normocapnic (PaCO2: 36-40 mmHg, n = 10) or hypercapnic (PaCO2: 45-50 mmHg, n = 10) PaCO2 regimen during rewarming. Results The maximum reduction of SjO2 occurred during rewarming with the jugular bulb temperature at 35-36 degrees C. In contrast, SjO2 did not change during rewarming from hypothermia in hypercapnic patients. Conclusions These results show that mild hypercapnia prevents the desaturation of SjO2 seen with the normocapnic group during the rewarming period from hypothermic CPB. These data suggest that mild hypercapnia during rewarming from CPB is associated with a better balance between cerebral oxygen supply and demand.

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A prospective, randomized comparison of cerebral venous oxygen saturation during normothermic and hypothermic cardiopulmonary bypass

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1016/1053-0770(94)90212-7 ◽

1994 ◽

Vol 8 (6) ◽

pp. 707

Keyword(s):

Cardiopulmonary Bypass ◽

Oxygen Saturation ◽

Hypothermic Cardiopulmonary Bypass ◽

Venous Oxygen Saturation ◽

Cerebral Venous Oxygen Saturation

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Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00424-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kota Saito ◽

Sho Ohno ◽

Makishi Maeda ◽

Naoyuki Hirata ◽

Michiaki Yamakage

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Oxygen Saturation ◽

Anesthetic Management ◽

Perioperative Period ◽

Maze Procedure ◽

Intraoperative Awareness ◽

Case Presentation ◽

Venous Oxygen Saturation ◽

Index Value

Abstract Background Remimazolam has less cardiovascular depressant effects than propofol in non-cardiac surgical patients. However, the efficacy and safety of remimazolam in cardiac surgery with cardiopulmonary bypass (CPB) have not been reported. We present a case of successful anesthetic management using remimazolam in cardiac surgery with CPB. Case presentation A 76-year-old female was scheduled for mitral valve repair, tricuspid annuloplasty, maze procedure, and left atrial appendage closure. We used remimazolam in induction (6.0 mg/kg/h) and maintenance (0.6–1.0 mg/kg/h) of general anesthesia, and the bispectral index value was maintained in the range of 36 to 48 including the period of CPB. Hemodynamics, mixed venous oxygen saturation, and bilateral regional cerebral oxygen saturation were maintained within acceptable ranges. There was no intraoperative awareness/recall or serious complications associated with remimazolam throughout the perioperative period. Conclusions Remimazolam can be used the same as other existing anesthetics in cardiac surgery with CPB.

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