Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
OA Selnes MA Goldsborough LM Borowicz GM Mckhann (1999) ArticleTitleNeurobehavioral sequelae of cardiopulmonary bypass Lancet 353 1601–6 Occurrence Handle10.1016/S0140-6736(98)07576-X Occurrence Handle1:STN:280:DyaK1M3msFCnsw%3D%3D Occurrence Handle10334272
VH Thourani WS Weintraub B Stein SP Gebhart JM Craver EL Jones et al. (1999) ArticleTitleInfluence of diabetes mellitus on early and late outcome after coronary artery bypass graft Ann Thorac Surg 67 1045–52 Occurrence Handle10.1016/S0003-4975(99)00143-5 Occurrence Handle1:STN:280:DyaK1M3ltF2qtQ%3D%3D Occurrence Handle10320249
Y Kadoi S Saito K Takahashi N Fujita F Goto (2004) ArticleTitleJugular venous oxygen saturation during mild hypothermic versus normother-mic cardiopulmonary bypass in elderly patients Surg Today 34 399–404 Occurrence Handle10.1007/s00595-003-2736-7 Occurrence Handle15108076
Y Sato S Ishikawa A Otaki T Takahashi Y Hasegawa T Koyano et al. (1999) ArticleTitlePostoperative brain complications following retrograde cerebral perfusion Surg Today 29 1034–9 Occurrence Handle10.1007/s005950050641 Occurrence Handle1:STN:280:DC%2BD3c%2FitFOhsg%3D%3D Occurrence Handle10554327
RF McLean BI Wong CD Naylor WG Snow EM Harrington M Gawel et al. (1994) ArticleTitleCardiopulmonary bypass, temperature, and central nervous dysfunction Circulation 90 II250–55 Occurrence Handle1:STN:280:ByqD2czis1c%3D Occurrence Handle7955261
ND Croughwell MF Newman JA Blumenthal WD White JB Lewis PE Frasco et al. (1994) ArticleTitleJugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass Ann Thorac Surg 58 1702–8 Occurrence Handle1:STN:280:ByqD2s%2Flt1Y%3D Occurrence Handle7979740
Y Kadoi S Saito F Goto N Fujita (2001) ArticleTitleDecrease in jugular venous bulb oxygen saturation during normothermic cardiopulmonary bypass predicts short-term postoperative neurological dysfunction in elderly patients J Am Coll Cardiol 38 1450–5 Occurrence Handle10.1016/S0735-1097(01)01584-4 Occurrence Handle1:STN:280:DC%2BD3MnktVOksw%3D%3D Occurrence Handle11691522
Y Kadoi S Saito F Kawahara F Goto R Owada N Fujita (2000) ArticleTitleJugular venous bulb oxygen saturation in patients with preexisting diabetes mellitus or stroke during normothermic cardiopulmonary bypass Anesthesiology 92 1324–9 Occurrence Handle10.1097/00000542-200005000-00021 Occurrence Handle1:STN:280:DC%2BD3c3ktlagtA%3D%3D Occurrence Handle10781277
Y Kadoi S Saito F Goto T Someya S Kamiyashiki N Fujita (2001) ArticleTitleTime course of changes in jugular venous oxygen saturation during hypothermic or normothermic cardiopulmonary bypass in patients with diabetic mellitus Acta Anaesthesiol Scand 45 858–62 Occurrence Handle10.1034/j.1399-6576.2001.045007858.x Occurrence Handle1:STN:280:DC%2BD3MvisVyjtw%3D%3D Occurrence Handle11472288
Y Kadoi S Saito F Goto N Fujita (2002) ArticleTitleSlow rewarming has no effects on the decrease in jugular venous oxygen hemoglobin saturation and long-term cognitive outcome in diabetic patients Anesth Analg 94 1395–401 Occurrence Handle10.1097/00000539-200206000-00004 Occurrence Handle12031995
Y Kadoi S Saito D Yoshikawa F Goto N Fujita F Kunimoto (2002) ArticleTitleIncreasing mean arterial pressure has no effect on jugular venous oxygen saturation in insulin-dependent patients during tepid cardiopulmonary bypass Anesth Analg 95 266–72 Occurrence Handle10.1097/00000539-200208000-00002 Occurrence Handle12145032
Y Kadoi H Hinohara F Kunimoto S Saito M Ide H Hiraoka et al. (2003) ArticleTitleDiabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anesthesia Stroke 34 2399–403 Occurrence Handle10.1161/01.STR.0000090471.28672.65 Occurrence Handle12958324
T Goto A Yoshitake T Baba Y Shibata R Sakata H Uozumi (1997) ArticleTitleCerebral ischemic disorders and cerebral oxygen balance during cardiopulmonary bypass surgery: preoperative evaluation using magnetic resonance imaging and angiography Anesth Analg 84 5–11 Occurrence Handle10.1097/00000539-199701000-00002 Occurrence Handle1:STN:280:ByiC2c3pvVQ%3D Occurrence Handle8988991
N Croughwell M Lyth TJ Quill M Newman WJ Greeley LR Smith et al. (1990) ArticleTitleDiabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass Circulation 82 IssueIDs1 407–12 Occurrence Handle2372891
DS Prough AT Rogers DA Stump RC Roy AR Cordell J Phipps et al. (1991) ArticleTitleCerebral blood flow decreases with time whereas cerebral oxygen consumption remains stable during hypothermic cardiopulmonary bypass in humans Anesth Analg 72 161–8 Occurrence Handle1:STN:280:By6D1M%2FislI%3D Occurrence Handle1898686
F Pallas DF Larson (1996) ArticleTitleCerebral blood flow in the diabetic patient Perfusion 11 363–70 Occurrence Handle1:STN:280:ByiD2c3osF0%3D Occurrence Handle8888057
A Yoshitake T Goto T Baba Y Shibata (1999) ArticleTitleAnalysis of factors related to jugular venous oxygen saturation during cardiopulmonary bypass J Cardiothorac Vasc Anesth 13 160–4 Occurrence Handle10.1016/S1053-0770(99)90080-0 Occurrence Handle1:STN:280:DyaK1M3ksF2rsg%3D%3D Occurrence Handle10230949
K Nandate A Vuylsteke I Ratsep S Messahel A Oduro-Dominah DK Menon et al. (2000) ArticleTitleEffects of isoflurane, sevoflurane and propofol anaesthesia on jugular venous oxygen saturation in patients undergoing coronary artery bypass surgery Brit J Anaesth 84 631–3 Occurrence Handle1:CAS:528:DC%2BD3cXjslSrsr8%3D Occurrence Handle10844841
R Kawata K Nakakimura M Matsumoto K Kawai M Kunihiro T Sakabe (1998) ArticleTitleCerebrovascular CO2 reactivity during anesthesia in patients with diabetes mellitus and peripheral vascular disease Anesthesiology 89 887–93 Occurrence Handle10.1097/00000542-199810000-00013 Occurrence Handle1:STN:280:DyaK1cvkvFCgtA%3D%3D Occurrence Handle9778006
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Miyoshi, S., Morita, T., Kadoi, Y. et al. Analysis of the Factors Related to a Decrease in Jugular Venous Oxygen Saturation in Patients with Diabetes Mellitus During Normothermic Cardiopulmonary Bypass. Surg Today 35, 530–534 (2005). https://doi.org/10.1007/s00595-004-2977-0
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00595-004-2977-0