Decoding the Onset of Intraoperative Normal Pressure Perfusion Breakthrough with Near-Infrared Spectroscopy and Jugular Venous Oxygen Saturation Catheter in a Case of Arteriovenous Malformation Surgery

Multimodal monitoring can be a useful tool to design an appropriate anesthesia technique in the intraoperative period during the surgical excision of an intracerebral arteriovenous malformation (AVM). Intraoperatively, hyperperfusion syndrome can be attributed to causes like insufficient blood pressure control, occlusion of venous drainage before complete resection of arterial feeders, or inadequate hemostatic control of distended capillaries receiving arterial flow. We would like to highlight the potential role of near-infrared spectroscopy and jugular venous oxygen saturation catheter in detection of intraoperative normal perfusion pressure breakthrough and take necessary measures to prevent further insult with the help of this case report.

The Effects of Different MAC Values of Desflurane on Jugular Venous Oxygen Saturation in Coronary Artery Bypass Surgery

Objective: Desflurane is used in cardiac anesthesia because it provides hemodynamic stability and rapid recovery. In this study, the effects of using different minimal alveolar concentrations (MAC) of desflurane on jugular venous oxygen saturation (SjvO2) and hemodynamic parameters in coronary artery bypass surgery (CABG) were investigated. Methods: Sixty patients who were scheduled for CABG were divided into 3 groups after obtaining the hospital ethics committee and patient consent. Desflurane was used in these groups at 0.5, 1.0 and 1.5 MAC values, respectively. In addition to routine invasive catheterization, a retrograde jugular venous catheter was inserted. Hemodynamic data, SjvO2, other parameters and blood gas values were recorded before, during and after CPB. Results: SjvO2 values in all groups were not within the desaturation limit. Glucose, lactate, partial arterial O2 saturation (PaO2) and partial jugular venous O2 saturation (PjvO2) values remained normal. In each group, a decrease was observed in arterial and jugular venous O2 content difference O2CT (a-jv) values due to hypothermia and hemodilution at admission to CPB (p<0.05). Conclusion: SjvO2 reflects the balance between cerebral blood flow and cerebral oxygen metabolic rate and the adequacy of cerebral perfusion. In previous studies; The effects of isoflurane, sevoflurane and desflurane on SjvO2 at 0.5 MAC level during CABG were investigated. The effects of the three inhalation agents on SjvO2 were similar. It was determined that cerebral autoregulation was not impaired and SjvO2 values did not decrease in 3 different MAC values of desflurane used in our study. However, it was observed that 0.5 MAC dose, which was also reflected in the hemodynamic findings, did not suppress the stress response sufficiently, and higher MAC values provided hemodynamic stability, especially in hypertensive patients. 1.5 MAC causes hypotension in some patients and vasopressor drugs may be needed. Hemodynamic stability is provided at a MAC value of 1.0.