Abstract
BackgroundCerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB).MethodsTo evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium.ResultsDelirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027).ConclusionsIn patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.
Highlights
Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery
After IRB approval, we reviewed the electronic medical records of all patients aged over 18 years who had undergone coronary artery bypass graft surgery (CABG) between October 2004 and December 2016
The results of this study suggest that decreases in intraoperative Regional cerebral oxygen saturation (rSO2) below 50% are associated with postoperative delirium after off pump coronary artery bypass graft surgery (OPCAB)
Summary
Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue continuously and non-invasively, especially during general anesthesia [1]. Using near-infrared spectroscopy (NIRS), cerebral oximetry measures regional cerebral oxygen saturation (rSO2) by analyzing the different intensities of light at specific wavelengths transmitted and received [2, 3] and monitor rSO2 underlying frontal lobes, which are vulnerable to hypoxic and hypotensive injury [4]. Among post-cardiac surgery neurologic complications, the reported prevalence of delirium is from 3.1% up to 52% by population and diagnostic methods, with higher prevalence in older population and aortic surgery patients, and more detection with precise cognitive function test by highly trained personnel [6,7,8,9]. Among neurologic complications, delirium is a serious and relatively common neurologic complication
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