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Jugular bulb saturation and cognitive dysfunction after cardiopulmonary bypass

Authors
Journal
The Annals of Thoracic Surgery
0003-4975
Publisher
Elsevier
Publication Date
Volume
58
Issue
6
Identifiers
DOI: 10.1016/0003-4975(94)91666-7
Disciplines
  • Education
  • Medicine
  • Psychology

Abstract

Abstract Inadequate cerebral oxygenation during cardiopulmonary bypass may lead to postoperative cognitive dysfunction in patients undergoing cardiac operations. A psychological test battery was administered to 255 patients before cardiac operation and just before hospital discharge. Postoperative impairment was defined as a decline of more than one standard deviation in 20% of tests. Variables significantly ( p < 0.05) associated with postoperative cognitive impairment are baseline psychometric scores, largest arterial-venous oxygen difference, and years of education. Jugular bulb hemoglobin saturation is significant if it replaces arterial-venous oxygen difference in the model. Factors correlated with jugular bulb saturation at normothermia were cerebral metabolic rate of oxygen consumption ( r = -0.6; p < 0.0005), cerebr al blood flow ( t = 0.4; p < 0.0,105), oxygen delivery ( r = 0.4; p < 0.0005), and mean arterial pressure ( r = 0.15; p < 0.05). Three measures were significantly related to desaturation at normothermia and at hypothermia as well: greater cerebral oxygen extraction, greater arterial-venous oxygen difference, and lower ratio of cerebral blood flow to arterial-venous oxygen difference. We conclude that cerebral venous desaturation occurs during cardiopulmonary bypass in 17% to 23% of people and is associated with impaired postoperative cognitive test performance.

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