Surgery Today

, Volume 35, Issue 7, pp 530–534 | Cite as

Analysis of the Factors Related to a Decrease in Jugular Venous Oxygen Saturation in Patients with Diabetes Mellitus During Normothermic Cardiopulmonary Bypass

  • Sohtaro Miyoshi
  • Toshihiro Morita
  • Yuji Kadoi
  • Fumio Goto



We sought to examine what factors, including cerebrovascular carbon dioxide (CO2) reactivity, are related to a decrease in internal jugular venous oxygen saturation (SjvO2) during normothermic cardiopulmonary bypass (CPB) in patients with diabetes mellitus.


Twenty-three diabetic patients scheduled to undergo elective coronary artery bypass grafting were studied. As a control, 27 age-matched control patients without diabetes mellitus were also examined. After the induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to continuously monitor SjvO2. Arterial and jugular venous blood gases were measured during CPB. The cerebrovascular CO2 reactivity was measured after the induction of anesthesia and before the start of surgery using a 2.5-MHz pulsed transcranial Doppler probe.


The SjvO2 values in the diabetic group were lower than those in the control group at the initiation of CPB and at 20, 40, and 60 min after the start of CPB. The values for pre- and post-CO2 reactivity in the control group did not significantly differ (pre-CPB: 4.8% ± 2.3% mmHg−1; post-CPB: 5.9% ± 4.4% mmHg−1). In contrast, the values for CO2 reactivity were lower post CPB than pre-CPB in the diabetic group (Pre-CPB: 6.3% ± 2.9% mmHg−1; post-CPB: 4.7% ± 2.6% mmHg−1; P < 0.05). In the diabetic group, glycosylated hemoglobin A1c (HbA1c) is considered to be a factor related to a decrease in SjvO2 during CPB.


Cerebrovascular CO2 reactivity in diabetic patients decreased after the cessation of CPB but not in the control patients. In addition, HbA1c is also thought to be a factor related to a decrease in SjvO2 in diabetic patients.

Key words

Diabetes mellitus Jugular venous oxygen saturation Cardiac surgery Cerebrovascular carbon dioxide reactivity Glycosylated hemoglobin 


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  1. 1.
    Selnes, OA, Goldsborough, MA, Borowicz, LM, Mckhann, GM 1999Neurobehavioral sequelae of cardiopulmonary bypassLancet35316016CrossRefPubMedGoogle Scholar
  2. 2.
    Thourani, VH, Weintraub, WS, Stein, B, Gebhart, SP, Craver, JM, Jones, EL,  et al. 1999Influence of diabetes mellitus on early and late outcome after coronary artery bypass graftAnn Thorac Surg67104552CrossRefPubMedGoogle Scholar
  3. 3.
    Kadoi, Y, Saito, S, Takahashi, K, Fujita, N, Goto, F 2004Jugular venous oxygen saturation during mild hypothermic versus normother-mic cardiopulmonary bypass in elderly patientsSurg Today34399404CrossRefPubMedGoogle Scholar
  4. 4.
    Sato, Y, Ishikawa, S, Otaki, A, Takahashi, T, Hasegawa, Y, Koyano, T,  et al. 1999Postoperative brain complications following retrograde cerebral perfusionSurg Today2910349CrossRefPubMedGoogle Scholar
  5. 5.
    McLean, RF, Wong, BI, Naylor, CD, Snow, WG, Harrington, EM, Gawel, M,  et al. 1994Cardiopulmonary bypass, temperature, and central nervous dysfunctionCirculation90II25055PubMedGoogle Scholar
  6. 6.
    Croughwell, ND, Newman, MF, Blumenthal, JA, White, WD, Lewis, JB, Frasco, PE,  et al. 1994Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypassAnn Thorac Surg5817028PubMedGoogle Scholar
  7. 7.
    Kadoi, Y, Saito, S, Goto, F, Fujita, N 2001Decrease in jugular venous bulb oxygen saturation during normothermic cardiopulmonary bypass predicts short-term postoperative neurological dysfunction in elderly patientsJ Am Coll Cardiol3814505CrossRefPubMedGoogle Scholar
  8. 8.
    Kadoi, Y, Saito, S, Kawahara, F, Goto, F, Owada, R, Fujita, N 2000Jugular venous bulb oxygen saturation in patients with preexisting diabetes mellitus or stroke during normothermic cardiopulmonary bypassAnesthesiology9213249CrossRefPubMedGoogle Scholar
  9. 9.
    Kadoi, Y, Saito, S, Goto, F, Someya, T, Kamiyashiki, S, Fujita, N 2001Time course of changes in jugular venous oxygen saturation during hypothermic or normothermic cardiopulmonary bypass in patients with diabetic mellitusActa Anaesthesiol Scand4585862CrossRefPubMedGoogle Scholar
  10. 10.
    Kadoi, Y, Saito, S, Goto, F, Fujita, N 2002Slow rewarming has no effects on the decrease in jugular venous oxygen hemoglobin saturation and long-term cognitive outcome in diabetic patientsAnesth Analg941395401CrossRefPubMedGoogle Scholar
  11. 11.
    Kadoi, Y, Saito, S, Yoshikawa, D, Goto, F, Fujita, N, Kunimoto, F 2002Increasing mean arterial pressure has no effect on jugular venous oxygen saturation in insulin-dependent patients during tepid cardiopulmonary bypassAnesth Analg9526672CrossRefPubMedGoogle Scholar
  12. 12.
    Kadoi, Y, Hinohara, H, Kunimoto, F, Saito, S, Ide, M, Hiraoka, H,  et al. 2003Diabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anesthesiaStroke342399403CrossRefPubMedGoogle Scholar
  13. 13.
    Goto, T, Yoshitake, A, Baba, T, Shibata, Y, Sakata, R, Uozumi, H 1997Cerebral ischemic disorders and cerebral oxygen balance during cardiopulmonary bypass surgery: preoperative evaluation using magnetic resonance imaging and angiographyAnesth Analg84511CrossRefPubMedGoogle Scholar
  14. 14.
    Croughwell, N, Lyth, M, Quill, TJ, Newman, M, Greeley, WJ, Smith, LR,  et al. 1990Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypassCirculation8240712PubMedGoogle Scholar
  15. 15.
    Prough, DS, Rogers, AT, Stump, DA, Roy, RC, Cordell, AR, Phipps, J,  et al. 1991Cerebral blood flow decreases with time whereas cerebral oxygen consumption remains stable during hypothermic cardiopulmonary bypass in humansAnesth Analg721618PubMedGoogle Scholar
  16. 16.
    Pallas, F, Larson, DF 1996Cerebral blood flow in the diabetic patientPerfusion1136370PubMedGoogle Scholar
  17. 17.
    Yoshitake, A, Goto, T, Baba, T, Shibata, Y 1999Analysis of factors related to jugular venous oxygen saturation during cardiopulmonary bypassJ Cardiothorac Vasc Anesth131604CrossRefPubMedGoogle Scholar
  18. 18.
    Nandate, K, Vuylsteke, A, Ratsep, I, Messahel, S, Oduro-Dominah, A, Menon, DK,  et al. 2000Effects of isoflurane, sevoflurane and propofol anaesthesia on jugular venous oxygen saturation in patients undergoing coronary artery bypass surgeryBrit J Anaesth846313PubMedGoogle Scholar
  19. 19.
    Kawata, R, Nakakimura, K, Matsumoto, M, Kawai, K, Kunihiro, M, Sakabe, T 1998Cerebrovascular CO2 reactivity during anesthesia in patients with diabetes mellitus and peripheral vascular diseaseAnesthesiology8988793CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Sohtaro Miyoshi
    • 1
  • Toshihiro Morita
    • 1
  • Yuji Kadoi
    • 2
  • Fumio Goto
    • 3
  1. 1.Department of AnesthesiologySaitama Cardiovascular and Pulmonary CenterSaitamaJapan
  2. 2.Departments of Intensive Care, Graduate School of MedicineGunma UniversityMaebashiJapan
  3. 3.Departments of Anesthesiology, Graduate School of MedicineGunma UniversityMaebashiJapan

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