Skip to main content

Advertisement

SpringerLink
Log in

Association between cerebrovascular carbon dioxide reactivity and postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Our intent was to identify whether cerebrovascular CO2 reactivity in diabetic patients is a risk factor for postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery.

Methods

One hundred twenty-four diabetic patients undergoing elective CABG were studied and analyzed. Diabetic patients were divided into three groups: normal CO2 reactivity group (above 5%/mmHg), medium CO2 reactivity group (between 5 and 3%/mmHg), or impaired CO2 reactivity group (below 3%/mmHg). After the induction of anesthesia and before the start of surgery, cerebrovascular CO2 reactivity was measured for all patients. Hemodynamic parameters (arterial and jugular venous blood gas values) were measured during cardiopulmonary bypass. All patients underwent a battery of neurological and neuropsychological tests the day before surgery, 7 days after surgery, and 6 months after surgery.

Results

At 7 days, the rate of cognitive dysfunction in the impaired CO2 group was higher than in the other three groups (normal, 30%; medium, 25%; impaired, 57%; *P < 0.01 compared with the other groups). In contrast, at 6 months postoperatively, no significant difference in the rate of cognitive dysfunction was found among the three groups. Age, hypertension, CO2 reactivity, the duration for which jugular venous oxygen saturation (SjvO2) was less than 50%, ascending aorta atherosclerosis, diabetic retinopathy, and insulin therapy were independent predictors of short-term cognitive dysfunction in diabetic patients, and HbA1c, diabetic retinopathy, and insulin therapy were independent predictors of long-term cognitive dysfunction in diabetic patients.

Conclusions

We found that impaired cerebrovascular CO2 reactivity was associated with postoperative short-term cognitive dysfunction in diabetic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hogue CW, Murphy SF, Schechtman KB, Davila-Roman VG. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100:642–7.

    PubMed  Google Scholar 

  2. Newman MF, Wolman R, Kanchuger M, Marschall K, Mora-Mangano C, Roach G, Smith LR, Aggarwal A, Nussmeier N, Herskowitz A, Mangano DT. Multicenter prospective stroke risk index for patients undergoing coronary artery bypass graft surgery. Circulation. 1996;94(suppl II):74–80.

    Google Scholar 

  3. Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med. 1996;335:1857–63.

    Article  PubMed  CAS  Google Scholar 

  4. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395–402.

    Article  PubMed  CAS  Google Scholar 

  5. Newman MF, Croughwell ND, Blumenthal JA, Lowry E, White WD, Spillane W, Davis RD Jr, Glower DD, Smith LR, Mahanna EP. Predictors of cognitive decline after cardiac operation. Ann Thorac Surg. 1995;59:1326–30.

    Article  PubMed  CAS  Google Scholar 

  6. Croughwell N, Lyth M, Quill TJ, Newman M, Greeley WJ, Smith LR, Reves JG. Diabetic patients have abnormal cerebral autoregulation during cardiopulmonary bypass. Circulation. 1990;82(suppl):IV407–12.

    Google Scholar 

  7. Kadoi Y, Saito S, Fujita N, Goto F. Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes. J Thorac Cardiovasc Surg. 2005;129:576–83.

    Article  PubMed  Google Scholar 

  8. Kadoi Y, Saito S, Goto F, Fujita N. Decrease in jugular venous oxygen saturation during normothermic cardiopulmonary bypass predicts short-term postoperative neurologic dysfunction in elderly patients. J Am Coll Cardiol. 2001;38:1450–5.

    Article  PubMed  CAS  Google Scholar 

  9. Kadoi Y, Saito S, Kawahara F, Goto F, Owada R, Fujita N. Jugular venous bulb oxygen saturation in patients with preexisting diabetes mellitus or stroke during normothermic cardiopulmonary bypass. Anesthesiology. 2000;92:1324–9.

    Article  PubMed  CAS  Google Scholar 

  10. Kadoi Y, Saito S, Goto F, Someya T, Kamiyashiki S, Fujita N. Time course of changes in jugular venous oxygen saturation during hypothermic or normothermic cardiopulmonary bypass in patients with diabetic mellitus. Acta Anaesthesiol Scand. 2001;45:858–62.

    Article  PubMed  CAS  Google Scholar 

  11. Kadoi Y, Saito S, Yoshikawa D, Goto F, Fujita N, Kunimoto F. Increasing mean arterial blood pressure has no effect on jugular venous oxygen saturation in insulin-dependent patients during tepid cardiopulmonary bypass. Anesth Analg. 2002;95:266–72.

    PubMed  Google Scholar 

  12. Kadoi Y, Saito S, Goto F, Fujita N. Slow rewarming has no effects on the decrease in jugular venous oxygen hemoglobin saturation and long-term cognitive outcome in diabetic patients. Anesth Analg. 2002;94:1395–401.

    PubMed  Google Scholar 

  13. Kadoi Y, Hinohara H, Kunimoto F, Saito S, Ide M, Hiraoka H, Kawahara F, Goto F. Diabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anesthesia. Stroke. 2003;34:2399–403.

    Article  PubMed  Google Scholar 

  14. Miyoshi S, Morita T, Kadoi Y, Goto F. Analysis of the factors related to a decrease in jugular venous oxygen saturation in patients with diabetes mellitus during normothermic cardiopulmonary bypass. Surg Today. 2005;35:530–4.

    Article  PubMed  CAS  Google Scholar 

  15. Kessler C, Junge HM, Walker ML, Busack R, Albrecht DM, Ackeren KV. Reduced cerebral vasomotor reactivity as an indicator of postoperative confusion. Anaesthesia. 1997;52:433–7.

    Article  PubMed  CAS  Google Scholar 

  16. Kadoi Y, Kawauchi C, Ide M, Kuroda M, Takahashi K, Saito S, Mizutani A. Preoperative depression is a risk factor for postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus. J Anesth. 2011;25:10–7.

    Article  PubMed  Google Scholar 

  17. Murkin JM, Newman SP, Stump DA, Blumenthal JA. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg. 1995;59:1289–95.

    Article  PubMed  CAS  Google Scholar 

  18. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405012.

    Article  Google Scholar 

  19. Pallas F, Larson DF. Cerebral blood flow in the diabetic patients. Perfusion. 1996;11:363–70.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Graduate School of Medicine and Saitama Prefectural Cardiovascular Center, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan

    Yuji Kadoi, Chikara Kawauchi, Masataka Kuroda, Kenichiro Takahashi & Shigeru Saito

  2. Department of Anesthesia, Keiyu Orthopedic Hospital and Saitama Prefectural Cardiovascular Center, Tatebayashi, Japan

    Nao Fujita

  3. Department of Anesthesiology, Oita University Graduate School of Medicine, Oita, Japan

    Akio Mizutani

Authors
  1. Yuji Kadoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chikara Kawauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masataka Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenichiro Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shigeru Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nao Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akio Mizutani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yuji Kadoi.

About this article

Cite this article

Kadoi, Y., Kawauchi, C., Kuroda, M. et al. Association between cerebrovascular carbon dioxide reactivity and postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus. J Anesth 25, 641–647 (2011). https://doi.org/10.1007/s00540-011-1182-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-011-1182-8

Keywords

Search

Navigation