• Norikazu Miura, Kenji Yoshitani, Masahiko Kawaguchi, Masahide Shinzawa, Tomoya Irie, Osamu Uchida, Yoshihiko Ohnishi, and G Burkhard Mackensen.
• Department of Anesthesiology, National Cardiovascular Center, Suita, Osaka, Japan.
• J Anesth. 2009 Jan 1;23(4):477-82.

PurposeOff-pump coronary artery bypass grafting surgery (OPCAB) frequently results in significant jugular bulb desaturation. Although jugular bulb desaturation during OPCAB may be associated with postoperative cerebral injury, routine jugular bulb oximetry appears to be invasive and expensive. We hypothesized that intraoperative hemodynamic compromise during OPCAB due to cardiac displacement is associated with jugular bulb desaturation which correlates with specific hemodynamic and physiological changes.MethodsHemodynamic and physiological data were measured at the following points: (1) before anastomosis of the coronary artery (baseline); (2) during anastomosis of the left anterior descending artery; (3) during anastomosis of the circumflex branch or posterior descending artery; and (4) after chest closure. Arterial, mixed venous, and jugular venous bulb blood gas analyses were performed serially.ResultsJugular bulb desaturation (or= 8 mmHg were likely predictors of the occurrence of jugular bulb desaturation.ConclusionChanges in S(VO2) and Pa(CO2) were associated with jugular bulb oxygen saturation, and S(VO2) or= 8 mmHg had a significant odds ratio for jugular bulb desaturation. We suggest that achieving normal values of S(VO2), Pa(CO2) and CVP may be important to prevent cerebral desaturation during OPCAB.

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