Postoperative brain complications following retrograde cerebral perfusion

Management of potential gas embolus during closure of an atrial septal defect in a three-year-old

Gas embolism occurring in adult patients supported with cardiopulmonary bypass is usually associated with mechanical complications. Management of gas embolism is less often described for the pediatric or neonatal patient. Measures to counteract gas embolism must be undertaken immediately if a satisfactory outcome is to be achieved. Here, the management of a three-year-old female patient, who was undergoing repair of a secundum atrial septal defect when the aortic cannula became dislodged and air entered the aorta, is described. Immediate implementation of an air embolism protocol, including (among other maneuvers) removal of air from the circuit, retrograde cerebral perfusion via the superior vena cava, and induction of cerebral hypothermia, may have aided in an acceptable outcome.

Analysis of the factors related to a decrease in jugular venous oxygen saturation in patients with diabetes mellitus during normothermic cardiopulmonary bypass

PURPOSE

We sought to examine what factors, including cerebrovascular carbon dioxide (CO(2)) reactivity, are related to a decrease in internal jugular venous oxygen saturation (SjvO(2)) during normothermic cardiopulmonary bypass (CPB) in patients with diabetes mellitus.

METHODS

Twenty-three diabetic patients scheduled to undergo elective coronary artery bypass grafting were studied. As a control, 27 age-matched control patients without diabetes mellitus were also examined. After the induction of anesthesia, a fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to continuously monitor SjvO(2). Arterial and jugular venous blood gases were measured during CPB. The cerebrovascular CO(2) reactivity was measured after the induction of anesthesia and before the start of surgery using a 2.5-MHz pulsed transcranial Doppler probe.

RESULTS

The SjvO(2) values in the diabetic group were lower than those in the control group at the initiation of CPB and at 20, 40, and 60 min after the start of CPB. The values for pre- and post-CO(2) reactivity in the control group did not significantly differ (pre-CPB: 4.8% +/- 2.3% mmHg(-1); post-CPB: 5.9% +/- 4.4% mmHg(-1)). In contrast, the values for CO(2) reactivity were lower post CPB than pre-CPB in the diabetic group (Pre-CPB: 6.3% +/- 2.9% mmHg(-1); post-CPB: 4.7% +/- 2.6% mmHg(-1); P < 0.05). In the diabetic group, glycosylated hemoglobin A1c (HbA1c) is considered to be a factor related to a decrease in SjvO(2) during CPB.

CONCLUSIONS

Cerebrovascular CO(2) reactivity in diabetic patients decreased after the cessation of CPB but not in the control patients. In addition, HbA1c is also thought to be a factor related to a decrease in SjvO(2) in diabetic patients.