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You are here: Back issues » acp-2009 » acp-3-2009 » 01_schoen

Association between cerebral desaturation and an increased risk of stroke in patients undergoing deep hypothermic circulatory arrest for cardiothoracic surgery

J. Schön1, V. Serien1, H. Heinze1, T. Hanke2, M. Bechtel2, S. Eleftheriadis4, H.-V. Groesdonk1, L. Dübener3, M. Heringlake1
Departments of 1Anesthesiology and 2Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany; 3Department of Cardiovascular Surgery, Children’s National Medical Center, Washington, DC, USA; 4Department of Anesthesiology, General Univeresity Hospital of Alexandroupolis, Greece
[Applied Cardiopulmonary Pathophysiology 13: 201-207, 2009]


Objective: To determine the relationship between a decrease in cerebral oxygen saturation (rSO2) – determined by near-infrared spectroscopy – below 80% of preoperative baseline and the incidence of stroke in patients undergoing deep hypothermic circulatory arrest (DHCA) for cardiac and/or thoracic aortic surgery.
Setting: Cardiac anesthesia unit of a University Hospital 
Design: Retrospective analysis of the anesthesia charts and the institutional cardiac surgery database for the year 2006.
Patients: 51 patients undergoing DHCA monitored bi-hemispherically with an INVOS 5100 cerebral oxymeter.
Interventions: None
Measurements and main results: Patients were grouped according to an rSO2 less or greater than 80% of baseline for the left or right hemisphere in a desaturation (n = 11) and a no-desaturation group (n = 40). No between group differences in demographic variables and preoperative baseline rSO2 were observed. Duration of cardiopulmonary bypass, aortic cross-clamp, DHCA and effective cerebral ischemia were not different between the groups. The minimal absolute and relative rSO2-levels in the desaturation group were significantly lower than in the no-desaturation group. Two patients in the desaturation group but none in the no-desaturation group presented with a postoperative stroke (18.1% vs. 0%; p = 0.043).
Conclusion: These findings suggest that an rSO2 lower than 80% of preoperative baseline in patients undergoing cardiac and/or thoracic aortic surgery with DHCA is associated with a significant risk of an adverse neurological outcome. Preventing cerebral desaturation during DHCA procedures may thus help to reduce postoperative neurological deficits.

Keywords: near-infrared spectroscopy, cerebral oxygenation monitoring, thoracic vascular surgery, cardiac surgery

Address for corresponding:
Matthias Heringlake, M.D., Ph.D., Klinik für Anästhesiologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck; Germany
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