HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Reich, D. L. Articles by Uysal, S. Search for Related Content PubMed PubMed Citation Articles by Reich, D. L. Articles by Uysal, S. Related Collections Anesthesia Cerebral protection Extracorporeal circulation Great vessels Related Article

Eur J Cardiothorac Surg 2004;25:401-406
© 2004 Elsevier Science NL

Using jugular bulb oxyhemoglobin saturation to guide onset of deep hypothermic circulatory arrest does not affect post-operative neuropsychological function

Departments of Anesthesiology and Biomathematical Sciences, Mount Sinai School of Medicine, New York, NY 10029, USA

Received 4 June 2003; received in revised form 23 October 2003; accepted 27 November 2003.

^* Corresponding author. Address: Department of Anesthesiology, Box 1010, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA. Tel.: +1-212-241-7467; fax: +1-212-241-1847
e-mail: david.reich{at}msnyuhealth.org

Objectives: Deep hypothermic circulatory arrest (DHCA) is commonly used during thoracic aortic surgery, and is initiated only after a sufficient degree of cerebral hypothermia is induced. The criteria for initiating DHCA vary among institutions: most centers use temperature criteria, some use electroencephalography, and a minority use jugular bulb oxyhemoglobin saturation SjO₂ criteria. The purpose of this study was to determine whether the use of SjO₂ monitoring to guide the onset of DHCA was associated with better post-operative neuropsychological outcome. Methods: Sixty-one thoracic aortic surgical patients underwent both pre- and post-operative neuropsychological testing. Patients were divided into three groups: (1) those with SjO₂95% at DHCA onset; (2) those with SjO₂<95% at DHCA onset; and (3) those without SjO₂ monitoring. Results: There were no statistically significant differences in the incidence of post-operative decline in neuropsychological function among the three groups of patients. Patients in whom SjO₂ data were used to guide onset of DHCA had lower esophageal and bladder temperatures at that time compared with patients without SjO₂ monitoring. Conclusions: Monitoring of SjO₂ had no apparent effect upon post-operative neuropsychological outcome, and there were no trends in our small patient cohort suggesting differences that our study was not adequately powered to detect. Use of SjO₂ monitoring was associated with more profound hypothermia prior to DHCA due to more prolonged cooling in attempts to bring the SjO₂ above the 95% threshold. Using our institutional cooling protocol, SjO₂ monitoring does not appear to increase neuroprotection in patients undergoing DHCA for thoracic aortic repairs.

Key Words: Aortic aneurysm • Thoracic • Thoracic surgery • Neuropsychology • Outcome study • Hypothermic circulatory arrest • Jugular bulb oxyhemoglobin saturation

Related Article

Editorial comment: Post-operative neuropsychological function unaffected by SjO₂ monitoring in DHCA

Teruhisa Kazui
Eur. J. Cardiothorac. Surg. 2004 25: 406-408. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				A. L. Estrera, Z. Garami, C. C. Miller III, R. Sheinbaum, T. T.T. Huynh, E. E. Porat, B. S. Allen, and H. J. Safi Cerebral monitoring with transcranial Doppler ultrasonography improves neurologic outcome during repairs of acute type A aortic dissection J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 277 - 285. [Abstract] [Full Text] [PDF]