Jugular Bulb Oxygen Research Articles

Normal jugular bulb oxygen saturation

Background: Normal values of the jugular bulb oxygen saturation were obtained in 1942 and in 1963. Correct catheter positioning was not confirmed radiologically. Objectives: To replicate the measurements during angiographic...

Increased cortical cerebral blood flow by continuous infusion of adrenaline (epinephrine) during experimental cardiopulmonary resuscitation

Objective: To study the effects of continuously administered adrenaline (epinephrine), compared to bolus doses, on the dynamics of cortical cerebral blood flow during experimental cardiopulmonary resuscitation (CPR), and after restoration of spontaneous circulation (ROSC). Methods: Ventricular fibrillation was induced in 24 anaesthetised pigs. After a 5-min non-intervention interval, closed-chest CPR was started. The animals were randomised into two groups. One group received three boluses of adrenaline (20 μg/kg) at 3-min intervals. The other group received an initial bolus of adrenaline (20 μg/kg) followed by an infusion of adrenaline (10 μg/kg min). After 9 min of CPR, defibrillation was attempted, and if spontaneous circulation was achieved the adrenaline infusion was stopped. Cortical cerebral blood flow was measured continuously using Laser–Doppler flowmetry. Jugular bulb oxygen saturation was measured to reflect global cerebral oxygenation. Repeated measurements of 8-iso-prostaglandin F 2α (8-iso-PGF 2α) in jugular bulb plasma were performed to evaluate cerebral oxidative injury. Results: During CPR mean cortical cerebral blood flow was significantly higher ( P=0.009) with a continuous adrenaline infusion than with repeated bolus doses. Following ROSC there was no significant difference in cortical cerebral blood flow between the two study groups. No differences in coronary perfusion pressure, rate of ROSC, jugular bulb oxygen saturation or 8-iso-PGF 2α were seen between the study groups. Conclusions: Continuous infusion of adrenaline (10 μg/kg min) generated a more sustained increase in cortical cerebral blood flow during CPR as compared to intermittent bolus doses (20 μg/kg every third minute). Thus, continuous infusion might be a more appropriate way to administer adrenaline as compared to bolus doses during CPR.

Hypothermia does not alter somatosensory evoked potential amplitude and global cerebral oxygen extraction during marked sodium nitroprusside-induced arterial hypotension.

To prevent neurologic damage, monitoring cerebral function by somatosensory evoked potentials is used in selected settings. Excision of intraocular melanoma provides a unique opportunity to assess independently during anesthesia the effects on median nerve somatosensory evoked potentials (MN-SSEPs) and cerebral oxygen extraction of sodium nitroprusside-evoked arterial hypotension with and without hypothermia. Median nerve somatosensory evoked potentials, arterial pressure, jugular venous bulb oxygen saturation (Sjo(2)) and lactate concentration, and arterial-jugular bulb oxygen content difference were assessed during propofol-remifentanil anesthesia under sodium nitroprusside-evoked arterial hypotension (mean arterial pressure, 40 mmHg) with and without surface hypothermia (32 degrees C) in 11 otherwise healthy patients undergoing resection of choroidal melanoma. Hypothermia alone did not affect peak-to-peak amplitude of N20/P25 but prolonged cortical latency of N20 (22.6 +/- 2.2 vs. 25.9 +/- 2.5 ms, P < 0.05), cervical latency of N13 (14.3 +/- 1.2 vs. 15.7 +/- 1.6 ms, P < 0.05), and central conduction time (8.3 +/- 1.4 vs. 10.2 +/- 1.6 ms, P < 0.05). Evoked arterial hypotension did not depress MN-SSEP N20/P25 amplitude either with or without hypothermia (-0.31 vs. -0.28 microV, P > 0.05) or alter latency (0.08 vs. 0.1 ms, P > 0.05). Furthermore, hypotension with or without hypothermia did not change Sjo(2), arterial-jugular bulb oxygen content difference, or lactate concentration. Thus, hypothermia to 32 degrees C does not alter MN-SSEP amplitude and global cerebral oxygen extraction during marked sodium nitroprusside-induced arterial hypotension with a mean arterial pressure of 40 mmHg but prolongs MN-SSEP latencies during propofol-remifentanil anesthesia in individuals without cerebrovascular disease.

This Month in ANESTHESIOLOGY

This Month in ANESTHESIOLOGY

Effectiveness of the Cobra aortic catheter for dual-temperature management during adult cardiac surgery

Objectives: In animals the Cardeon Cobra catheter (Cardeon Corp, Cupertino, Calif) allows independent control of aortic arch and descending aortic temperatures and profoundly reduces cerebral embolization during bypass. This investigation describes the first clinical use of the device during adult cardiac surgery. The purpose of the study was to confirm that the Cobra catheter delivers adequate cerebral and systemic perfusion while providing simultaneous cerebral hypothermia and systemic normothermia during cardiopulmonary bypass. Methods: In a prospective multicenter study the Cobra aortic catheter was placed in 20 adults undergoing cardiopulmonary bypass. Arch and corporeal temperatures, bypass flows, and arterial blood pressures were recorded intraoperatively. Jugular bulb and mixed venous oxygen saturation was used to assess the adequacy of cerebral and systemic perfusion. Results: Surgeons at 3 institutions placed the Cobra catheter in patients undergoing coronary artery bypass grafting (n = 13), valve (n = 3), and combined valve-bypass (n = 4) operations. Mean total bypass flows of 2.1 ± 0.2 L · min−1 · −2 maintained mean arterial pressures in arch and descending aortic circulations of greater than 55 mm Hg. A mean differential of 4.3°C between arch and descending aortic temperatures was established before crossclamp application, and a mean maximum temperature differential of 7°C was established during bypass. A 2.4°C temperature differential was maintained at crossclamp removal. Cerebral and systemic venous oxygen saturation remained greater than 65% during bypass. Conclusions: The Cobra device met all expectations for an arterial cannula with adequate perfusion to the arch and corporeal circulations. Dual perfusion with the Cobra catheter allows for independent temperature control during cardiopulmonary bypass with simultaneous cerebral hypothermia and systemic normothermia.J Thorac Cardiovasc Surg 2003;125:378-84

Effect of Clonidine Supplementation on Jugular Bulb Oxygen Saturation and Carbon Dioxide Reactivity during Desflurane Anesthesia

Background: The -agonist clonidine is an adjunct in general anesthesia. Clonidine constricts cerebral arteries and decreases cerebral blood flow (CBF), but does not alter cerebral metabolic rate (CMR). Thus cerebral ischemia is possible due to CBF/CMR imbalance. This study was designed to prove the effects of clonidine bolus up on CBF and reactivity in desflurane anesthesia. Methods: Thirty patients were divided into a clonidine group (n = 15) and a control group (n = 15). Anesthesia was induced with thiopental and pancuronium, and maintained with 50% / Desflurane. The jugular bulb was cannulated to measure jugular bulb oxygen saturation (). MAP and were measured after induction, after clonidine (/kg) or normal saline administration and during hyperventilation. Results: After clonidine administration, MAP decreased from 95.7 9.8 mmHg to 81.1 6.3 mmHg and was 79.9 5.0 mmHg during hyperventilation. In the control group, the corresponding MAP values 95.7 9.8 mmHg, 81.1 6.3 mmHg and 79.9 5.0 mmHg. After clonidine administration, was decreased from 84.7 3.7% to 81.1 5.2%, and was 71.5 8.4% during hyperventilation (P = 0.003, P = 0.000) and in control group, there were 95.7 9.8%, 81.1 6.3% and 79.9 5.0%, respectively. reactivity was expressed as a change of per unit change of , 1.15 1.19%/mmHg versus 1.43 0.98%/mmHg (P = 0.49). Conclusions: During desflurane anesthesia, clonidine-induced constriction of the cerebral arteries was demonstrated but reactivity was well preserved.

Propofol, Nitrous Oxide, and Jugular Bulb Oxygen Saturation

Propofol, Nitrous Oxide, and Jugular Bulb Oxygen Saturation

Jugular Bulb Oxygen Saturation during Propofol and Sevoflurane/Nitrous Oxide Anesthesia during Deliberate Mild Hypothermia for Neurosurgical Procedures

Jugular Bulb Oxygen Saturation during Propofol and Sevoflurane/Nitrous Oxide Anesthesia during Deliberate Mild Hypothermia for Neurosurgical Procedures

The Effect of Nitrous Oxide on Jugular Bulb Oxygen Saturation During Remifentanil Plus Target-Controlled Infusion Propofol or Sevoflurane in Patients with Brain Tumors

During propofol/fentanyl anesthesia, a large percentage of patients have jugular bulb oxygen saturation (Sjo2) <50%. The incidence is less with isoflurane/N2O. We evaluated the effect of N2O on Sjo2 during remifentanil-based anesthesia with concurrent propofol or sevoflurane in 20 adults undergoing brain tumor surgery. Anesthesia was randomized: Group 1 (n = 10), target-controlled infusion propofol; and Group 2 (n = 10), thiopental 2–3 mg/kg followed by sevoflurane 0.9% end-tidal. Jugular bulb and arterial blood samples for gas analysis were withdrawn during the administration of oxygen 33% with nitrogen 67% and then with N2O 67%. All samples were drawn before surgery and 20 min after the addition of the study gas and with an ETco2 26–28 mm Hg and mean arterial pressure >90 mm Hg. Both groups had similar demographic and physiologic data. In the Propofol group, Sjo2 was 50% ± 10% with nitrogen and 52% ± 9% with N2O (not significant); in the Sevoflurane group, however, N2O 67% increased Sjo2 from 56% ± 13% to 66% ± 12% (P < 0.01). This indicates that N2O does not reduce the incidence of low Sjo2 values during propofol anesthesia.

Is there a correlation between neurone-specific enolase and jugular venous bulb oxygen saturation during CABG

s: European Association of Cardiothoracic Anaesthesiologists; 17th Annual Meeting; Dublin, Ireland; June 12-15, 2002: Cardiopulmonary Bypass and Surgery

Effects of Propofol Used with an Inhalation Anesthetic in the Neuroanesthetic Management on the Jugular Bulb Oxygen Saturation

Background: When we use a volatile anesthetic that increases cerebral blood flow (CBF) and propofol which decreases CBF in appropriate doses, respectively, an increase in ICP and cerebral ischemia can be prevented. The purpose of this study was to look for the proper method for balanced anesthesia using a jugular bulb oxygen saturation () that depends on the concentration of propofol used in combination with isoflurane- anesthesia. Methods: Randomly we divided these patients into group 1 (12 patients), group 2 (12 patients), and group 3 (15 patients). Using a Master TCI and injecting a volatile anesthetic continuously, we injected 2/ml of blood concentration to group 1, 3/ml to group 2 and 4/ml to group 3 and maintained a partial pressure of in the vein around 30 mmHg during the operation. After induction of anesthesia, injection of propofol, and the dura mater was opened, we measured mean arterial blood pressure, heart rate, respectively, measured partial pressure of , hematocrit, oxygen saturation sampling the arterial blood, measured oxygen saturation sampling jugular bulb. Results: There were no differences of mean arterial blood pressure, heart rate, hematocrit, arterial blood partial pressure of , oxygen saturation, or jugular bulb oxygen saturation among the groups. In addition, there were no statistical differences of variables measured before and after injecting propofol and the dura was opened. For 1 in group 1, 2 in group 2, and 3 in group 3, jugular oxygen saturation dropped below 50% after injecting propofol, but was not verified statistically. Conclusions: There were no significant hemodynamic effects when we used propofol with the volatile anesthetic in neuroanesthetic management.

Detection of early ischemia in severe head injury by means of arteriovenous lactate differences and jugular bulb oxygen saturation. Relationship with CPP, severity indexes and outcome. Preliminary analysis.

Early ischemia may be highly relevant in patients with severe head injuries. The aims of the study were: 1) to define if abnormal arteriovenous lactate difference (AVDL) and jugular bulb oxygen saturation (SjO2) are found in the early 24 hrs post injury; 2) to compare if abnormalities of SjO2 and of AVDL were associated with a specific typology of severity indexes and outcome; 3) to detect any association between abnormal AVDL and SjO2 with levels of cerebral perfusion pressure (CPP). The study involved 29 patients, with CPP, AVDL and SjO2 measured within 24 hours post-injury. 1) Abnormal AVDL was found in 21% while abnormal SjO2 was detected in 38% of the patients; 2) abnormal AVDL was associated with cases of most severe injury; 3) CPP level below 60 mmHg was associated with abnormal AVDL and SjO2. Low CPP appeared to be the most likely measurable cause of early ischemia. Abnormalities of AVDL appeared to be more sensitive, than SjO2, with regard to detection of the most severe cases.

Incidence of intracranial hypertension related to jugular bulb oxygen saturation disturbances in severe traumatic brain injury patients.

To analyze the Intracranial Hypertension (IH) development related to jugular bulb oxygen saturation (SjO2) disturbances in severe traumatic brain injury patients (sTBI). One hundred and thirty-five sTBI patients were reviewed. Those without IH at admission (n = 116) were included. All patients underwent ICP and SjO2 continuous monitoring. Two groups were distinguished according to the SjO2 values during the first 24 hours. Group A: those with abnormal SjO2 (SjO2 more than 75% or less than 55%) and Group B: those with normal SjO2 (55-75%). Differences in IH development and outcome between groups were analyzed. Causes of abnormally low SjO2 were identified. IH developed in 56.9% of patients, between 12 and 48 hours from admission. Group A had a significantly higher incidence of IH than Group B (p < 0.001) and it also had a worse outcome than Group B (GOS 1-2) (p < 0.005). Patients from Group A had a risk of IH 4.5 fold higher than Group B. Considering only patients who developed IH, an abnormal SjO2 value increased 2.3 fold the risk of death compared to those without SjO2 disturbances. Main causes of SjO2 desaturation were hyperventilation (40.7%), hypovolemia (28.4%) and anemia (21%). Early detection of disturbances in oxygen supply-demand relationship and prevention or resolution of the secondary insults which produce these disturbances, might lead to a reduction in the incidence of intracranial hypertension.

Effects of desflurane on jugular bulb gases and pressure in neurosurgical patients.

The purpose of this study was to investigate the effect of different concentrations of desflurane on jugular bulb gases and jugular bulb pressure (JBP) and to determine an optimal concentration of desflurane in neurosurgical patients with supratentorial tumor. Twenty-two patients were anesthetized with desflurane in oxygen. Radial arterial and jugular bulb catheters were inserted for blood gas sampling and direct blood pressure measurement after anesthesia. Mean arterial blood pressure (MAP), heart rate (HR), and JBP were monitored continuously. Arterial and jugular bulb blood gases were measured at 0.7 minimum alveolar contraction (MAC) (4.2%), 1.0 MAC (6%), and 1.3 MAC (7.8%) of desflurane randomly after a 30-minute stabilization period, respectively. Jugular bulb oxygen saturation (S(J)O2) significantly increased and cerebral arteriojugular difference of oxygen content (A(J)DO2) and oxygen extraction ratio (O2ER) significantly decreased from 0.7 MAC to 1.0 MAC of desflurane, but there was no further increase in S(J)O2 nor further decreases in A(J)DO2 and O2ER at 1.3 MAC compared with 1.0 MAC desflurane. There was a significant dose-related decrease in MAP from 0.7 MAC to 1.3 MAC of desflurane, but JBP did not change significantly. No significant change in hour was observed in the study. It is concluded that 1.0 MAC is a suitable concentration of desflurane in neurosurgery with an improved balance between cerebral oxygen supply and demand.

Difference of Jugular Bulb Oxygen Saturation under Propofol, Enflurane and Isoflurane Anesthesia with Hydralazine-induced Deliberate Hypotension

Background: Hydralazine produces cerebral vasodilation, which could appear differently according to which kind of anesthetics was used. SjO, CBF and AJDO2 have been studied during general anesthesia with enflurane, isoflurane or propofol in 42 patients undergoing spinal surgery. Methods: Forty-two healthy adult patients were divided into Group P (Propofol-N2O, n = 15), Group E (Enflurane-N2O, n = 15) and Group I (Isoflurane-N2O, n = 12). During the course of the study, the anesthetic concentration was constant. Induced hypotension was provided with hydralazine 20 mg in combination with a continuous infusion of esmolol within 50-100g/kg/min. Arterial blood and jugular bulb blood were obtained and analyzed at normotensive and hypotensive period, respectively. SjO2, was compared within and between groups. Results: SjO values of Group P were 66.2 7.7%, and 81.5 ﾒ 6.1%, those of Group E were 79.5 5.6%, and 78.9 X 4.9% and those of Group I were 82.0 ･ 6.2%, and 84.4 ﾝ 3.7% at normotension and hypotension, respectively (P 0.05 between Group P and Group E, P 0.05 between Group P and Group I, P 0.05 within Group P). Conclusions: When the changes of CBF is assumed with that of SjO, it may be concluded that CBF increased with hydralazine-induced hypotension in propofol-N2O anesthesia. It may be suggested that hydralazine reverses propofol induced cerebral vasoconstriction.

A reply

We appreciate the interest of Dr Alston in our review article on jugular bulb oximetry during cardiac surgery [1]. We agree with him that bench oximetry, not fibreoptic catheters, is the gold standard for the measurement of jugular bulb oxygen saturation (Sjo2) during cardiopulmonary bypass (CPB). Dr Alston provides a perfectly valid explanation of why Sjo2 less than 50% occurs during cardiopulmonary bypass and why, postoperatively, hyperventilation leads to reduced arterial carbon dioxide tension (Paco2), cerebral vasoconstriction, decreased cerebral perfusion and hence increase in oxygen extraction and reduced Sjo2. We recently studied the effect of Paco2 on Sjo2[2], but found that it explains only 34% of the variance of Sjo2 during warm CPB. Recently, Robson and colleagues found that cognitive dysfunction at 3 months after CPB was not related to jugular bulb desaturation (Sjo2 < 50%) during or after CPB [3]. In their study, the authors did not report the early cognitive changes in the first week after CPB or its relation to Sjo2, which was reported by Croughwell et al. [4]. It would be very interesting to confirm this finding because it seems that jugular bulb desaturation may affect only short-term cognitive dysfunction. Low Sjo2 is a symptom of reduced oxygen availability to the brain and if values < 50% do not lead to long-term cerebral damage, we must presume that the brain can still function under this condition. However, there must be some lower limit of Sjo2 (20%, 30%, 40%?) below which cerebral damage will occur. Another factor might be cerebral damage arising from embolism, which would be minimised by reduced cerebral perfusion. We have tried to explain in our review article that Sjo2 does reflect global cerebral oxygenation but does not detect regional cerebral oxygenation. This was confirmed in our recent paper [5] where we found that Sjo2 did not reflect impairment of regional cerebral oxygenation detected by near-infrared spectroscopy (NIRS). Therefore, if brain injury is due to regional ischaemia, it may or may not be reflected by Sjo2. Thus, in attempting to optimise cerebral oxygenation during CPB, it is important to determine whether the aim should be to maintain good oxygenation of the brain or to minimise cerebral perfusion and hence the risk of embolism (while still maintaining adequate oxygenation – whatever this may be).

Current issues in spinal anesthesia.

Spinal anesthesia is an old, simple, and popular anesthetic technique, yet much remains unknown regarding pertinent anatomy, physiology, and pharmacology. Investigations into physiologic effects of spinal anesthesia reveal complex actions on multiple organ systems. New local anesthetics, analgesic additives, and techniques are being investigated for different applications as the practice of medicine focuses on outpatient care. Safety of spinal agents and complications from spinal anesthesia continue to be examined and re-examined to improve safety. Further study will be needed to fully resolve these issues and to further understand and improve the clinical use of spinal anesthesia.

Pediatric neurologic emergencies.

Neuroemergencies are life-threatening situations in which, whatever the cause, common pathologic phenomena result in secondary brain lesions. The goal of critical care management is to stop these self-aggravating processes as soon as possible. Initial resuscitation is devoted to control of the airway and hemodynamic and hydroelectrolytic stabilization. With mass lesions, minimal computed tomographic exploration immediately precedes surgical decompression. Further critical care adapted to the child's needs requires multimodal monitoring. Normoventilation, deep sedation, osmotherapy with mannitol or hypertonic saline solutions, and optimization of mean arterial pressure are the basis of management. A purely pressure-driven approach aimed at controlling cerebral perfusion pressure could be potentially harmful, and associated measurement of blood flow velocity with transcranial Doppler and jugular bulb oxygen saturation monitoring allows an approach to cerebral blood flow and metabolism. Outcome can be improved in dangerous situations such as severe brain injuries, cerebral arteriovenous malformation rupture, status epilepticus, and acute hydrocephalus, provided that emergency management could be applied efficiently.

Risk factors for disordered cerebral autoregulation during hypothermic cardiopulmonary bypass

Disordered cerebral autoregulation during cardiopulmonary bypass (CPB) is regarded as one of the causes of neurological dysfunction after cardiac surgery. However, little documentation of risk factors associated with cerebral autoregulation during CPB has been reported. Sixty consecutive patients undergoing coronary artery bypass were classified into subgroups according to whether they had preoperative cerebrovascular disease (CVD), hypertension (HT), or diabetes (DM). Cerebral oxygenation was monitored by jugular venous bulb oxygen saturation (SjvO2) and near-infrared spectroscopy parameter (%Oxy-Hb) during the operation, and the relationships between these values and intraoperative parameters were evaluated. The results showed that SjvO2 and %Oxy-Hb in the CVD+group were lower than in the CVD-group. Multiple stepwise regression analysis on SjvO2 and %Oxy-Hb in the CVD+ group revealed that only MAP was a predictive factor and that there was a positive correlation between MAP and both SjvO2 and %Oxy-Hb (r=.651,r=.693, respectively,P 0.0001), and the correlation was stronger in patients without any risk factors (r=.671,P=0.0001). The results suggested that patients with CVD, HT, and DM may experience failure of cerebral pressureflow autoregulation and cerebrovascular reactivity during CPB.

Changes in jugular bulb oxygenation in patients undergoing warm coronary artery bypass surgery (34-37oC)

Imbalance between cerebral oxygen supply and demand is thought to play an important role in the development of cerebral injury during cardiac surgery with cardiopulmonary bypass. We studied jugular bulb oxygen saturation, jugular bulb oxygen tension, arterial-jugular bulb oxygen content difference and oxygen extraction ratio in 20 patients undergoing warm coronary artery bypass surgery (34-37 degrees C) with pH-stat blood gas management. Only two patients showed desaturation (jugular bulb oxygen saturation < 50%) at 5 min on bypass, and none from 20 min onwards. Multiple regression models were performed after using bypass temperature, mean arterial pressure, cerebral perfusion pressure, haemoglobin concentration and arterial carbon dioxide tension as independent variables, and arterial-jugular bulb oxygen content difference, jugular bulb oxygen saturation, oxygen extraction ratio and jugular bulb oxygen tension as individual dependent variables. We found that jugular bulb oxygen saturation, jugular bulb oxygen tension and oxygen extraction ratio are mainly dependent on arterial carbon dioxide tension, and arterial-jugular bulb oxygen content difference is dependent on arterial carbon dioxide tension and the bypass temperature. Our results suggest jugular bulb oxygenation is mainly dependent on arterial carbon dioxide tension during warm cardiopulmonary bypass.