Abstract
The brain has high oxygen extraction, thus the regional cerebral tissue oxygen saturation (rSO2) is lower than the central venous oxygen saturation (ScvO2). We hypothesised that diabetes widens the physiological saturation gap between ScvO2 and rSO2 (gSO2), and the width of this gap may vary during various phases of cardiac surgery. Cardiac surgery patients with (n = 48) and without (n = 91) type 2 diabetes mellitus (T2DM) underwent either off-pump coronary artery bypass (OPCAB) or other cardiac surgery necessitating cardiopulmonary bypass (CPB) were enrolled. rSO2 was measured by near-infrared spectroscopy (NIRS) and ScvO2 was determined simultaneously from central venous blood. rSO2 was registered before and after anaesthesia induction and at different stages of the surgery. ScvO2 did not differ between the T2DM and control patients at any stage of surgery, whereas rSO2 was lower in T2DM patients, compared to the control group before anaesthesia induction (60.4 ± 8.1%[SD] vs. 67.2 ± 7.9%, p<0.05), and this difference was maintained throughout the surgery. After anaesthesia induction, the gSO2 was higher in diabetic patients undergoing CPB (20.2 ± 10.4% vs. 12.4 ± 8.6%, p < 0.05) and OPCAB grafting surgeries (17.0 ± 7.5% vs. 9.5 ± 7.8%, p < 0.05). While gSO2 increased at the beginning of CPB in T2DM and control patients, no significant intraoperative changes were observed during the OPCAB surgery. The wide gap between ScvO2 and rSO2 and their uncoupled relationship in patients with diabetes indicate that disturbances in the cortical oxygen saturation cannot be predicted from the global clinical parameter, the ScvO2. Thus, our findings advocate the monitoring value of NIRS in T2DM.
Highlights
In the perioperative period, the oxygen balance is routinely estimated from the oxygen saturation of central venous blood (ScvO2)[15]
Measurements were made during anaesthesia in two groups of cardiac surgery patients: those undergoing cardiopulmonary bypass (CPB) and those scheduled for off-pump coronary artery bypass (OPCAB) grafting procedure
haemoglobin A1c (HbA1c) was significantly higher in diabetic patients while there was no significant difference in the other parameters
Summary
The oxygen balance is routinely estimated from the oxygen saturation of central venous blood (ScvO2)[15]. Online monitoring of regional cerebral tissue oxygen saturation (rSO2) would have an advantage in T2DM patients in the intraoperative period to manage local hypoxemic episodes. We hypothesise that T2DM patients exhibit a significant widening of the gap between ScvO2 and rSO2 (gSO2), and ScvO2 is not suitable to infer rSO2 as a cardiovascular consequence of diabetes. To test this hypothesis, we aimed at comparing direct measurements of rSO2 using near-infrared spectroscopy (NIRS) to simultaneously obtained ScvO2 data in patients with and without T2DM. ScvO2, rSO2 and gSO2 are expected to exhibit intraoperative changes during cardiac surgery depending on the patient management with or without cardiopulmonary bypass (CPB). Measurements were made during anaesthesia in two groups of cardiac surgery patients: those undergoing CPB and those scheduled for off-pump coronary artery bypass (OPCAB) grafting procedure
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