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Determinants of cerebral oximetry in patients undergoing off-pump coronary artery bypass grafting: an observational study

Moritz, Stefan; Rochon, Justine; Völkel, Sabine; Hilker, Michael; Hobbhahn, Jonny; Graf, Bernhard M; Arlt, Matthias

European Journal of Anaesthesiology (EJA): June 2010 - Volume 27 - Issue 6 - p 542–549
doi: 10.1097/EJA.0b013e3283343ef8
Haemodynamics

Background and objective The present study investigated whether positioning of the heart during off-pump coronary artery bypass grafting leads to changes in regional cerebral oxygen saturation measured by near infrared spectroscopy.

Methods In 35 consecutive patients undergoing elective off-pump coronary artery bypass grafting, cerebral oxygen saturation was measured by near infrared spectroscopy. A 20% decrease from baseline values was considered to be cerebral hypoperfusion. Mean arterial pressure, cardiac index, arterial carbon dioxide partial pressure, central venous pressure, haemoglobin concentration, and body temperature were determined simultaneously. Each value was recorded at the following time points: at baseline; after positioning the heart for distal anastomoses of the left anterior descending artery, the circumflex, and the right coronary artery; after repositioning the heart; and after chest closure. Significant changes in each parameter from baseline were detected using repeated-measures analysis of variance. Determinants of cerebral oxygen saturation during surgery were analysed by means of generalized estimation equations.

Results Cerebral oxygen saturation remained constant during grafting of the left anterior descending artery and decreased significantly during grafting of the circumflex (P = 0.001) and the right coronary artery (P < 0.001). Cerebral hypoperfusion was found in seven (20%) patients. Changes in haemoglobin concentration (P = 0.014), arterial CO2 partial pressure (P = 0.001), cardiac output (P < 0.001), and central venous pressure (P = 0.014) determined alterations in cerebral oxygen saturation.

Conclusion Positioning of the heart during off-pump coronary artery bypass grafting leads to a decrease in regional cerebral oxygen saturation. This decrease is associated with changes in cardiac output, haemoglobin concentration, arterial CO2 partial pressure, and central venous pressure.

From the Department of Anaesthesiology (SM, SV, JH, BMG, MA), Department of Cardiovascular Surgery (MH) and Center for Clinical Studies (JR), University Hospital Regensburg, Regensburg, Germany

Received 1 July, 2009

Revised 12 October, 2009

Accepted 13 October, 2009

Correspondence to Dr Stefan Moritz, Department of Anaesthesiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany Tel: +49 941 944 7801; fax: +49 941 944 7802; e-mail: moritz.stefan@yahoo.de

The present study was presented in part at the Annual Meeting of the American Society of Anesthesiologists, San Francisco, California, 13–17 October 2007.

© 2010 European Society of Anaesthesiology