Perioperative cerebral infarct during cardiac surgery and changes in jugular venous O2 saturation and cerebral oximetry using near-infrared spectroscopy: A case report / 대한마취과학회지

Despite reductions in surgical mortality, neurologic sequelae remain a devastating complication after cardiac surgery with cardiopulmonary bypass. Neurologic complications may be induced by a massive air embolism during cardiopulmonary bypass, even with extensive monitoring. This report describes a patient who had a fatal cerebral infarct during aortic valve and ascending aorta replacement surgery. We monitored jugular venous O2 saturation (SjvO2) and cerebral oximetry using near-infrared spectroscopy in the perioperative period. The operation and anesthesia were uneventful until the deep hypothermic total arrest for the replacement of the ascending aorta. However, restarting the cardiopulmonary bypass after deep hypothermic total arrest produced a brief (less than 10 seconds) but large amount of air in the root cannula. At this time, although cerebral oximetry did not show any changes, the SjvO2 decreased to 21% for about 3 minutes and then normalized. At 8 hours after surgery, the patient showed seizures and severe edema in both cerebral hemispheres on the MRI. The patient died 21 days after surgery.

Continuous Monitoring of Jugular Venous Oxygen Saturation in Severe Head-injured Patients

The continuous measurement of jugular venous oxygen saturation(SjvO2) with a fibroptic catheter is evaluated as a method of detecting cerebral ischemia after head injury. Fifty patients admitted to the hospital who were unconscious after severe head injuries had continuous and simultaneous monitoring of SjvO2, intracranial pressure, arterial oxygen saturation, arterial blood pressure. Whenever SjvO2 dropped to less than 50%, a standardized protocol was followed to confirm the validity of the desaturation and to elucidate its cause. A total of 72 episodes of jugular venous oxygen desaturation occurred in 45 patients, possibly due to intracranial hypertension in 39 episodes, arterial hypoxia in 13, combinations of the above in 9, systemic hypotension in 7, and anemia in 4. Two episodes of hyp-eremia, SjvO2 more than 90%, occurred in 2 patients with carotid-cavernous fistula. The incidence of jugular venous oxygen desaturation found in this study suggests that continuous monitoring of SjvO2 may be of clinical value in patients with head injury.

Changes of Internal Jugular Venous Oxygen Content with Differences in Arterial CO2 Tension / 대한마취과학회지

The routine management of head injury includes hyperventilation to produce hypocapnis with arterial CO2 tension 25~30 torr. But a decrease in cerebral blood flow with hypocapnia may result in cerebral ischemia. Our study was to evaluate the change of cerebral blood flow during hyperventilation in halthane anesthesia. The jugular venous oxygen saturation(SjvO2), arterio-venous oxygen content difference(CaO2-CjvO2), and oxygen extraction ratio(O2ER) were used as criteria of cerebral ischemia with reduced cerebral blood flow. The results are as follows: 1) SjvO2 was lower in group 2(PaCO2=22.8torr) than group 1(PaCO2=30.3 torr). 2) CaO2-CjvO2 and O2ER were higher in Group 2 than group 1. 3) No more increased possibility of cerebral ischemia with reduced cerebral blood flow was observed Group 2 than group 1.