Jugular Bulb Venous Oxygen Saturation Research Articles

Comparing near-infrared spectroscopy-measured cerebral oxygen saturation and corresponding venous oxygen saturations in children with congenital heart disease: a systematic review and meta-analysis.

BackgroundNear-infrared spectroscopy (NIRS) is a non-invasive approach that measures cerebral regional oxygen saturation (rScO2). In this study, we evaluated the evidence on the validity of NIRS and the interchangeability between NIRS and common invasive approaches by exploring the correlation and consistency and comparing the mean and standard deviation between the NIRS rScO2 and jugular bulb venous oxygen saturation (SjvO2) as well as central venous oxygen saturation (ScvO2) in the perioperative period of children with congenital heart disease (CHD).MethodsWe searched electronic bibliographic databases (PubMed, The Cochrane Library and Embase) and screened the studies that met the inclusion criteria. We included cross-sectional studies of CHD pediatric patients in the perioperative period receiving both tests for NIRS rScO2 and SjvO2 or NIRS rScO2 and ScvO2. Methodological quality assessment and heterogeneity analyses were performed. We qualitatively summarized the results of Bland-Altman’s analysis. Meta-regression, subgroup analyses, and sensitivity analyses were carried out to explore the causes of heterogeneity.ResultsThere was no significant difference in Cohen’s d between rScO2 and ScvO2 or between rScO2 and SjvO2 (Cohen’s d =0.06, 95% CI: −0.16 to 0.28; Cohen’s d =0.03, 95% CI: −0.25 to 0.31, respectively) and notable heterogeneity existed (I2=76.0%, P<0.001; I2=73.6%, P<0.001, respectively). A positive linear correlation was present between rScO2 and ScvO2 or between rScO2 and SjvO2 (r=0.58, 95% CI: 0.54 to 0.63; r=0.60, 95% CI: 0.54 to 0.66, respectively) and the heterogeneity was not significant (I2=36.7%, P=0.065; I2=12.7%, P=0.328, respectively). In most studies, the 95% limits of agreements of Bland-Altman’s analysis were large. No evidence of publication bias was observed.ConclusionsThe rScO2 measured by NIRS reflected the SjvO2 and ScvO2 monitored by invasive measurements in the perioperative period of children with CHD to some extent. However, wide limits of agreements between rScO2 and SjvO2 as well as ScvO2 indicated that NIRS and SjvO2 as well as ScvO2 are not interchangeable. Whether NIRS plays a prominent role in monitoring cerebral oxygen saturation in children with CHD needs further research.

Brain Hypoxia Secondary to Diffusion Limitation in Hypoxic Ischemic Brain Injury Postcardiac Arrest.

We sought to characterize 1) the difference in the diffusion gradient of cellular oxygen delivery and 2) the presence of diffusion limitation physiology in hypoxic-ischemic brain injury patients with brain hypoxia, as defined by parenchymal brain tissue oxygen tension less than 20 mm Hg versus normoxia (brain tissue oxygen tension > 20 mm Hg). Post hoc subanalysis of a prospective study in hypoxic-ischemic brain injury patients dichotomized into those with brain hypoxia versus normoxia. Quaternary ICU. Fourteen adult hypoxic-ischemic brain injury patients after cardiac arrest. Patients underwent monitoring with brain oxygen tension, intracranial pressure, cerebral perfusion pressure, mean arterial pressure, and jugular venous bulb oxygen saturation. Data were recorded in real time at 300Hz into the ICM+ monitoring software (Cambridge University Enterprises, Cambridge, United Kingdom). Simultaneous arterial and jugular venous bulb blood gas samples were recorded prospectively. Both the normoxia and hypoxia groups consisted of seven patients. In the normoxia group, the mean brain tissue oxygen tension, jugular venous bulb oxygen tension, and cerebral perfusion pressure were 29 mm Hg (SD, 9), 45 mm Hg (SD, 9), and 80 mm Hg (SD, 7), respectively. In the hypoxia group, the mean brain tissue oxygen tension, jugular venous bulb oxygen to brain tissue oxygen tension gradient, and cerebral perfusion pressure were 14 mm Hg (SD, 4), 53 mm Hg (SD, 8), and 72 mm Hg (SD, 6), respectively. There were significant differences in the jugular venous bulb oxygen tension-brain oxygen tension gradient (16 mm Hg [sd, 6] vs 39 mm Hg SD, 11]; p < 0.001) and in the relationship of jugular venous bulb oxygen tension-brain oxygen tension gradient to cerebral perfusion pressure (p = 0.004) when comparing normoxia to hypoxia. Each 1 mm Hg increase in cerebral perfusion pressure led to a decrease in the jugular venous bulb oxygen tension-brain oxygen tension gradient by 0.36 mm Hg (95% CI, -0.54 to 0.18; p < 0.001) in the normoxia group, but no such relation was demonstrable in the hypoxia group. In hypoxic-ischemic brain injury patients with brain hypoxia, there is an elevation in the jugular venous bulb oxygen tension-brain oxygen tension gradient, which is not modulated by changes in cerebral perfusion pressure.

Validation of a Second-Generation Near-Infrared Spectroscopy Monitor in Children With Congenital Heart Disease.

Cerebral oximetry using near-infrared spectroscopy is a noninvasive optical technology to detect cerebral hypoxia-ischemia and develop interventions to prevent and ameliorate hypoxic brain injury. Cerebral oximeters are calibrated and validated by comparison of the near-infrared spectroscopy-measured cerebral O2 saturation (SctO2) to a "field" or reference O2 saturation (REF CX) calculated as a weighted average from arterial and jugular bulb oxygen saturations. In this study, we calibrated and validated the second-generation, 5 wavelength, FORE-SIGHT Elite with the medium sensor (source-detector separation 12 and 40 mm) for measurement of SctO2 in children with congenital heart disease. After institutional review board approval and written informed consent, 63 children older than 1 month and ≥2.5 kg scheduled for cardiac catheterization were enrolled. Self-adhesive FORE-SIGHT Elite medium sensors were placed on the right and left sides of the forehead. Blood samples for calculation of REF CX were drawn simultaneously from the aorta or femoral artery and the jugular bulb before (T1) and shortly after (T2) baseline hemodynamic measurements. FORE-SIGHT Elite SctO2 measurements were compared to the REF CX (REF CX = [0.3 SaO2] + [0.7 SjbO2]) using Deming regression, least squares linear regression, and Bland-Altman analysis. Sixty-one subjects (4.5 [standard deviation 4.4] years of age; 17 [standard deviation 13] kg, male 56%) completed the study protocol. Arterial oxygen saturation ranged from 64.7% to 99.1% (median 96.0%), jugular bulb venous oxygen saturation from 34.1% to 88.1% (median 68.2%), the REF CX from 43.8% to 91.4% (median 76.9%), and the SctO2 from 47.8% to 90.8% (median 76.3%). There was a high degree of correlation in SctO2 between the right and left sensors at a given time point (within subject between sensor correlation r = 0.91 and 95% confidence interval [CI], 0.85-0.94) or between T1 and T2 for the right and left sensors (replicates, within subject between time point correlation r = 0.95 and 95% CI, 0.92-0.96). By Deming regression, the estimated slope was 0.966 (95% CI, 0.786-1.147; P = .706 for testing against null hypothesis of slope = 1) with a y intercept of 2.776 (95% CI, -11.102 to 16.654; P = .689). The concordance correlation coefficient was 0.873 (95% CI, 0.798-0.922). Bland-Altman analysis for agreement between SctO2 and REF CX that accounted for repeated measures (both in times and sensors) found a bias of -0.30% (95% limits of agreement: -10.56% to 9.95%). This study calibrated and validated the FORE-SIGHT Elite tissue oximeter to accurately measure SctO2 in pediatric patients with the medium sensor.

Efficacy of volume therapy guided by stroke volume variability in patients undergoing surgery for severe traumatic brain injury

Objective To evaluate the efficacy of volume therapy guided by stroke volume variability (SVV) in the patients undergoing surgery for severe traumatic brain injury. Methods Thirty patients of both sexes with severe traumatic brain injury, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅲ, who were admitted to the hospital within 24 h after injury, with Glasgow Coma Scale (GCS) score≤8, were divided into control group (C group, n=15) and SVV group (n=15) using a random number table method.In group C, conventional fluid administration was performed to maintain mean arterial pressure at 65-110 mmHg, central venous pressure at 5-12 cmH2O and urine volume>1 ml·kg-1·h-1.Fluid was given according to SVV, maintaining SVV≤13% and mean arterial pressure at 65-110 mmHg in group SVV.Immediately after skin incision (T0), immediately after opening cerebral dura mater (T1), at 1 h after opening cerebral dura mater (T2), immediately after suturing cerebral dura mater (T3) and at the end of operation (T4), blood samples were collected from the radial artery and internal jugular venous bulb for blood gas analysis, the jugular venous oxygen partial pressure, jugular venous bulb oxygen saturation, blood lactate, arterial oxygen partial pressure, arterial oxygen saturation and Hb were recorded, and the cerebral artery and arteriovenous blood O2 content difference and cerebral O2 extraction rate were calculated.Blood samples were collected from the internal jugular venous bulb at T0-2, T4 and 24 h after operation (T5) for determination of S100β protein concentrations by enzyme-linked immunosorbent assay.The intraoperative volume of fluid intake and output and consumption of vasoactive drugs were recorded.GCS scores were recorded immediately after admission to the operating room, and at 1, 3, 7 and 14 days after operation.The development of postoperative length of hospitalization and complications (pulmonary infection and brain edema) was recorded.Glasgow Outcome Scale Score was used to assess the early postoperative quality of life. Results Compared with group C, the urine volume was significantly increased, the consumption of vasoactive drugs was reduced, jugular venous bulb oxygen saturation was increased at T2, 3, the cerebral O2 extraction rate was decreased at T2-4, the serum S100β protein concentration was decreased at T2, and the GCS score was increased at day 3 after operation (P 0.05). Conclusion SVV-guided volume therapy can improve cerebral oxygen metabolism, ensure adequate tissue perfusion and reduce craniocerebral injury in the patients undergoing surgery for severe traumatic brain injury. Key words: Stroke volume; Fluid therapy; Craniocerebral trauma

Characteristics and advances of monitoring techniques in carotid endarterectomy

Background Carotid endarterectomy(CEA) is one of the major choices for the treatment of carotid stenosis. A variety of intraoperative monitoring and management techniques were used to respectively detect and reverse cerebral ischemia. However, the incidences of perioperative complications and stroke are still as high as 5%. Appropriate anesthetic management might be of great importance to lower the incidences. Objective To review studies in anesthetic monitoring and management during CEA. Content CEA has been used to eliminate plaques deposited on the wall of carotid. To perform this surgery, both upstream and downstream parts of carotid around the plaques have to be clamped, which produces transient cerebral ischemia, usually followed by complications. To prevent the complications, perioperative monitoring techniques have been performed to fulfill real-time measurement of hemodynamic and neurophysiological parameters. The techniques include cerebral regional oxygen saturation, stump pressure, transcranial doppler, even-related potentials, jugular bulb venous oxygen saturation, and consciousness during awake, etc. This paper reviews the principles and advancements of these techniques and also their application in CEA. Trend During CEA, combinatory monitoring of multiple parameters may be necessary to obtain synthetic feedback information to improve safety and prognosis of the patients. Key words: Carotid endarterectomy; Cerebral ischemia; Anesthetic monitoring; Perioperative management

Comparison of the cerebroprotective effect of inhalation anaesthesia and total intravenous anaesthesia in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and meta-analysis

ObjectiveNeurological dysfunction remains a devastating postoperative complication in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), and previous studies have shown that inhalation anaesthesia and total intravenous anaesthesia (TIVA) may...

Agreement between regional cerebral oxygen saturation and jugular bulb venous oxygen saturation during one-lung ventilation in elderly patients

Objective To evaluate the agreement between regional cerebral oxygen saturation(rSO2)and jugular bulb venous oxygen saturation(SjvO2)during one-lung ventilation(OLV)in elderly patients. Methods Twenty-two patients of both sexes, aged 65-76 yr, with body mass index of 21-32 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing open pulmonary lobectomy or radical resection of esophageal cancer with combined intravenous-inhalational anesthesia, were selected.Immediately after beginning of two-lung ventilation(T0), at stable two-lung ventilation in the lateral position(T1), at 5, 25 and 45 min of OLV in the lateral position(T2-4)and at the end of OLV in the lateral position(T5), blood samples were collected from the jugular bulb for blood gas analysis, and SjvO2 was recorded.rSO2 was also recorded at the time points mentioned above.Bland-Altman analysis was used to evaluate the agreement. Results SjvO2 was significantly lower at T0-5 than rSO2(P<0.05). rSO2 and SjvO2 were gradually decreased at T1-5(P<0.05). The results of Bland-Altman analysis showed that the difference between rSO2 more than 95% and SjvO2 was within the range of 95% limits of agreement, and the absolute value of the maximum difference was 20.8%. Conclusion There is a good agreement between rSO2 and SjvO2 during OLV in elderly patients, and SjvO2 can be recommended as an alternative to rSO2 clinically. Key words: Respiration, artificial; Brain; Oxygen; Aged

Effect of therapeutic hypercapnia on cerebral oxygen metabolism in patients undergoing thoracoscopic surgery in beach chair position

Objective To evaluate the effect of therapeutic hypercapnia on cerebral oxygen metabolism in the patients undergoing thoracoscopic surgery in beach chair position (BCP). Methods Sixty patients of both sexes, aged 18-32 yr, with body mass index of 19-24 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective bilateral thoracic sympathectomy performed via a thoracoscope, were divided into control group (group C) and hypercapnia group (group H), with 30 patients in each group using a random number table.After induction of anesthesia, all the patients in both groups were tracheally intubated and mechanically ventilated using the ventilation regimen low tidal volume intermittent positive pressure ventilation combined with low level of positive end-expiratory pressure (5 cmH2O), maintaining arterial carbon dioxide partial pressure (PaCO2) at 35-45 mmHg.PaCO2 was maintained at 45-55 mmHg by adjusting the respiratory rate after the patients were placed in BCP in group H. Anesthesia was maintained with target-controlled infusion of propofol and intermittent intravenous boluses of rocuronium and sufentanil.Bispectral index value was maintained at 45-55.Before anesthesia induction (baseline), at 5 min after intubation, and at 5, 10, 15 and 20 min after the patients were placed in BCP, blood samples were taken from the radial artery and jugular bulb for blood gas analysis, jugular venous bulb oxygen saturation was measured, and arteriovenous blood O2 content difference, cerebral O2 extraction rate, and venous to arterial blood lactate concentration difference were calculated. Results Compared with group C, PaCO2 and jugular venous bulb oxygen saturation were significantly increased, and arteriovenous blood O2 content difference and cerebral O2 extraction rate were significantly decreased at at 5, 10, 15 and 20 min after the patients were placed in BCP in group H (P 0.05). Conclusion Therapeutic hypercapnia can improve the cerebral oxygen metabolism in the patients undergoing thoracoscopic surgery in BCP. Key words: Hypercapnia; Posture; Oxygen consumption; Brain

Abstract PR283

Background & Objectives: The objective of this study was to evaluate the effect of hypothermic cardiopulmonary bypass (CPB) on cerebral oxygen saturation (rSO2), internal jugular bulb venous oxygen saturation (SjvO2), mixed venous oxygen saturation (SvO2), and bispectral index (BIS) used to monitor cerebral oxygen balance in pediatric patients. Materials & Methods: Sixty American Society of Anesthesiologists Class II-III patients aged 1 to 4 years old with congenital heart disease scheduled for elective cardiac surgery were included in this study. Temperature, BIS, rSO2, mean arterial pressure, central venous pressure, cerebral perfusion pressure (CPP), and hematocrit were recorded. Internal jugular bulb venous oxygen saturation and SvO2 were obtained from blood gas analysis at the time points: after induction of anesthesia (T0), beginning of CPB (T1), ascending aortic occlusion (T2), 20 minutes after initiating CPB (T3), coronary reperfusion (T4), separation from CPB (T5), and at the end of operation (T6). The effect of hypothermia or changes in CPP on rSO2, SjvO2, SvO2, and BIS were analyzed. Results: Compared with postinduction baseline values, rSO2 significantly decreased at all-time points: onset of extracorporeal circulation, ascending aortic occlusion, 20 minutes after CPB initiation, coronary reperfusion, and separation from CPB (P<0.05). Compared with measurements made following induction of anesthesia, SjvO2 significantly increased with initiation of CPB, ascending aortic occlusion, 20 minutes after initiating CPB, coronary reperfusion, and separation from CPB (P<0.05). Compared with induction of anesthesia, BIS significantly decreased with the onset of CPB, aortic cross clamping, 20 minutes after initiating CPB, and coronary reperfusion (P<0.05). Bispectral index increased following separation from CPB. There was no significant change in SvO2 during cardiopulmonary bypass (P > 0.05). Correlation analysis demonstrated that rSO2 was positively related to CPP (r =0.687, P=0.000), with a low linear correlation to temperature (r=0.453, P=0.000). Internal jugular bulb venous oxygen saturation was negatively related to temperature (r=-0.689, P=0.000). Bispectral index was positively related to both temperature (r=0.824, P=0.000) and CPP (r=0.782, P=0.000). Cerebral oxygen saturation had a positive linear correlation with CPP and a low linear correlation to temperature. Internal jugular bulb venous oxygen saturation had a negative linear correlation to temperature. Conclusion: Pre-and and early postbypass periods are vulnerable times for adequate cerebral oxygenation. Anesthetic management must aim to optimize the supply and demand relationship Disclosure of Interest: None declared

Brain Oxygen Monitoring via Jugular Venous Oxygen Saturation in a Patient with Fulminant Hepatic Failure

Fulminant hepatic failure (FHF) is often accompanied by a myriad of neurologic complications, which are associated with high morbid-ity and mortality. Although appropriate neuromonitoring is recommended for early diagnosis and to minimize secondary brain injury, individuals with FHF usually have a high chance of coagulopathy, which limits the ability to use invasive neuromonitoring. Jugular bulb venous oxygen saturation (JvO₂) monitoring is well known as a surrogate direct measures of global brain oxygen use. We report the case of a patient with increased intracranial pressure due to FHF, in which JvO₂ was used for appropriate brain oxygen monitoring.

Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial.

One-lung ventilation (OLV) may impair cerebral oxygen balance and induce postoperative cognitive dysfunction (POCD). It is unclear whether the type of anesthetic influences the incidence of POCD in patients undergoing OLV. This prospective study compared the incidence of POCD and intraoperative cerebral oxygen desaturation in OLV patients anesthetized with propofol vs sevoflurane during lung surgery. There were 148 participants enrolled in this study and randomized equally to either the propofol or the sevoflurane group. Anesthesia was maintained with either propofol or sevoflurane combined in both groups with fentanyl and epidural anesthesia. Regional cerebral oxygen saturation (rSO2), jugular bulb venous oxygen saturation (SjO2), and the incidence of cerebral oxygen desaturation (rSO2 or SjO2 < 50% or rSO2 < 80% of baseline) were measured during anesthesia. Cognitive function was assessed using seven neurocognitive tests two days preoperatively, five days postoperatively (primary outcome), and three months postoperatively. Bivariable and multivariable regression analyses were conducted to identify factors associated with POCD. Rates of POCD did not differ statistically between groups five days postoperatively (propofol, 16/72 patients; sevoflurane, 24/72 patients; RR, 0.67; 95% CI, 0.39 to 1.15; P = 0.14) or three months postoperatively (propofol, 9/60 patients; sevoflurane, 12/58 patients; RR, 0.73; 95% CI, 0.33 to 1.59; P = 0.42). Only three subjects per group showed intraoperative cerebral oxygen desaturation. Multivariable regression analysis revealed older age as an independent predictor of POCD. No statistically significant difference in the incidence of POCD could be detected between the sevoflurane and propofol anesthesia groups. Postoperative cognitive dysfunction was relatively frequent following OLV in both groups. ( UMIN 000002826).

Traumatic Brain Injury: Treatment with Mild Prolonged Hypothermia

Introduction: Hypothermia has been used as a method of brain protection in patients with traumatic brain injury (TBI) for many years. The protective effects of hypothermia are related to the inhibition of the excitatory amino acids (EAA) release including glutamate. The hypothermic decline of the cerebral metabolic rate of oxygen is also another mechanism of brain protection because it maintains the aerobic metabolism of the brain. Aim of the work: To study the effect of mild hypothermia on the outcome and complications in severe head trauma. Patients and methods: Ninety four patients (16-60 years old) with severe head trauma (Glasgow coma scale ≤ 8) were classified into hypothermic group (n=47) and normothermic group (n=47). The jugular venous bulb oxygen saturation, the jugular venous lactate, the Glasgow outcome scale at hospital discharge (GOS-HD), the length of ICU stay and other variables were measured and recorded. Results: Mild hypothermia improved the jugular venous bulb oxygen saturation, decreased the jugular venous lactate, with no effect on (GOS-HD). Conclusion: Prophylactic mild hypothermia lacks any effect on the outcome in patients with TBI, although there is improvement in the cerebral oxygenation and decrease the oxygen extraction and prevention of the anaerobic metabolism by decreasing the level of serum lactate. A subgroup of patients with intracranial hematoma may benefit from this type of treatment.

Effects of propofol versus sevoflurane on cerebral oxygenation and cognitive outcome in patients with impaired cerebral oxygenation

BackgroundPostoperative neurocognitive dysfunction induced by anesthetics, particularly in elderly patients with impaired oxygenation, is a common complication of surgery and is eliciting increased interest in clinical practice. To investigate the effects of anesthetics on neurocognition, we compared the effects of propofol versus sevoflurane on cerebral oxygenation and cognitive outcome in patients with impaired cerebral oxygenation undergoing general anesthesia.MethodsSixty-three patients with impaired cerebral oxygenation (jugular venous bulb oxygen saturation [SjvO2] <50%) or cerebral blood flow/cerebral metabolic rate of oxygen ([CBF/CMRO2] ≤15%) undergoing elective abdominal surgery were randomly allocated into propofol group (group P) or sevoflurane group (group S). The clinical parameters and jugular venous bulb blood gas analysis were monitored throughout the surgical procedure. Cognitive function was assessed with the mini-mental state examination and Montreal Cognitive Assessment at day 1 and day 7 following surgery. S100β protein in plasma was measured using enzyme-linked immunosorbent assay.ResultsThe SjvO2 increased during anesthesia induction and surgery when compared to baseline but had no significant difference between group P and group S. When compared to baseline, the CBF/CMRO2 was increased only at the end of surgery and extubation in group P; however, the CBF/CMRO2 in group S was increased during anesthesia induction at 1 hour, 2 hours, end of surgery, and extubation. Furthermore, the CBF/CMRO2 in group S was significantly higher than that in group P during anesthesia induction at 1 hour, 2 hours, and end of surgery. S100β protein did not significantly change at extubation and 1 day after surgery in both groups when compared to baseline. There was no significant difference in mini-mental state examination and Montreal Cognitive Assessment scores between group P and group S at all time points.ConclusionSevoflurane showed similar effects in postoperative neurocognitive function as propofol but could improve cerebral oxygenation in patients with impaired cerebral oxygenation.

Effects of ulinastatin on cerebral oxygen metabolism and CRP levels in patients with severe traumatic brain injury.

The aim of the present study was to investigate the effects of ulinastatin on cerebral oxygen metabolism and C-reactive protein (CRP) levels in patients with severe traumatic brain injury (sTBI). A total of 92 patients with sTBI, admitted to the First Affiliated Hospital of Xinxiang Medical University (Xinxiang, China), were randomly divided into control and observation groups. The control group received conventional therapy plus a placebo (0.9% sodium chloride), while the observation group were administered conventional therapy plus 200,000 units ulinastatin via intravenous injection twice a day for seven days. Arterial and jugular venous blood was collected for blood gas analysis. The jugular venous blood lactate (JVBL), jugular venous bulb oxygen saturation (SjvO2), arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2) levels were measured on day 1, 3, 5 and 7, as well as the level of CRP in the peripheral blood. In the control group, the level of JVBL decreased as compared with the level at day 1, however, no statistically significant differences were observed (P>0.05). By contrast, the observation group exhibited a significant reduction in the level of JVBL (P<0.05), which was also significantly lower compared with the control group (P<0.05). Statistically significant differences were observed between the two groups with regard to SjvO2, AVDO2 and CEO2 on day 3, 5 and 7. The CRP levels in the two groups increased and peaked on day 3. However, the CRP level in the observation group significantly decreased on day 5 (35.27±15.18 mg/l) and day 7 (22.65±10.48 mg/l), which was lower compared with the control group (56.19±13.24 mg/l and 47.36±15.73 mg/l, respectively); statistically significant differences were observed (P<0.05). Therefore, ulinastatin effectively improved cerebral oxygen metabolism and reduced the CRP level in patients with sTBI.

Effects of target-controlled infusion of propofol or sevoflurane combined with remifentanil on cerebral oxygen metabolism：a comparison study

Objective To compare the effects of target-controlled infusion(TCI)between propofol/remifentanil and sevoflurane/remifentanil during anesthesia on cerebral oxygen metabolism in patients undergoing brain tumor surgery,so as to provide references for clinical practice.Methods A double-blind randomized,controlled trial was conducted with sixty participants,which were equally assigned to two groups.Patients in the PR Group were induced by TCI of propofol/remifentanil combination and those in the SR Group were anesthetized with sevoflurane/remifentanil combination.Blood samples were collected at different time points to measure jugular bulb venous oxygen saturation(SjvO2)and generate arteriovenous oxygen content difference(Da-jvO2).The hemodynamic parameters and duration of surgery or anesthesia of each participant were also monitored and recorded.Results No significant difference was found regarding to the hemodynamic parameters or duration of surgery/anesthesia between the two groups.SjvO2 was found significantly higher and Da-jvO2 was significantly lower in the SR group than those in the PR group(P0.01).Conclusion Combined anesthesia with propofol/remifentanil vs sevoflurane/remifentanil are both safe for patients undergoing cerebral tumor operation;and sevoflurane/remifentanil seems to provide better oxygen supply and has more rapid post-operation recovery;however,sevoflurane/remifentanil can improve cerebral oxygenation.

Under General Anesthesia Arginine Vasopressin Prevents Hypotension but Impairs Cerebral Oxygenation During Arthroscopic Shoulder Surgery in the Beach Chair Position

Patients undergoing surgery in the beach chair position (BCP) are at a risk of cerebral ischemia. We evaluated the effect of arginine vasopressin (AVP) on hemodynamics and cerebral oxygenation during surgery in the BCP. Thirty patients undergoing shoulder surgery in BCP under propofol-remifentanil anesthesia were randomly allocated either to receive IV AVP 0.07 U/kg (AVP group, N = 15) or an equal volume of saline (control group, N = 15) 2 minutes before taking BCP. Mean arterial blood pressure (MAP), heart rate (HR), jugular venous bulb oxygen saturation (SjvO2), and regional cerebral tissue oxygen saturation (SctO2) were measured after induction of anesthesia and before (presitting in supine position) and after patients took BCP. AVP itself given before the positioning increased MAP and decreased SjvO2 and SctO2 (P < 0.0001), with HR unaffected. Although MAP was decreased by BCP in both groups, it was higher in the AVP group (P < 0.0001). While in BCP, HR remained unaltered in the control and decreased in the AVP group. SjvO2 in BCP did not differ between the groups. SctO2 was decreased by BCP in both groups, which was more pronounced in the AVP group until the end of study. The incidence of hypotension (13% vs 67%; P = 0.003) was less frequent, and that of cerebral desaturation (>20% SctO2 decrease from presitting value) (80% vs 13%; P = 0.0003) was higher in the AVP group. The incidence of jugular desaturation (SjvO2 <50%) was comparable between the groups. A prophylactic bolus administration of AVP prevents hypotension associated with BCP in patients undergoing shoulder surgery under general anesthesia. However, it was associated with regional cerebral but not jugular venous oxygen desaturation on upright positioning.

Cerebral oxygen desaturation monitored by intraoperative near-infrared spectroscopy, and incidence of post-operative cognitive dysfunction: a systematic review protocol

Review question/objective The objective of this systematic review is to determine if there is a direct relationship between cerebral oxygen desaturation using intraoperative near-infrared spectroscopy monitoring, and the incidence of post-operative cognitive dysfunction (POCD). Inclusion criteria Types of participants This systematic review will consider all patients over the age of eight years old receiving general anesthesia for any surgical procedure, since patients younger than this age usually have different anesthetic emergence and transfer processes than patients older than eight years of age. Patients with pre-existing neurologic disease including stroke, alcohol abuse, history of psychiatric disorders, and emergency cases will be excluded, since a baseline neurologic test cannot be performed appropriately. Focus of the review The systematic review considers studies that examine the use of NIRS or cerebral oximetry as a monitor for cerebral oxygen saturation and desaturation in patients receiving general anesthesia. Types of outcomes The systematic review will consider studies that included measurements of postoperative neurological deficit, and POCD related to cerebral oxygen desaturation as outcome measures. This cognitive decline is measured throughout the literature with various tools including the (MMSE), this test measures neurocognitive functions such as orientation, attention, and calculation, memory and language. Another tool is the Logical Memory Subtest of the Rivermead, which examines the immediate and delayed memory as well as the recovery capacity. Other tools include The Rey Auditory Verbal Learning Test and The Verbal Fluency Test and others. 8

Effects of sevoflurane before cardiopulmonary bypass on cerebral oxygen balance and early postoperative cognitive dysfunction

Postoperative cognitive dysfunction (POCD) is associated with cardiopulmonary bypass (CPB). We investigated the effect of different doses of inhaled sevoflurane administered prior to CPB on cerebral oxygen supply and demand, and the incidence of associated early POCD. One hundred and twenty patients were randomly allocated into four treatment groups (n = 30, each) and administered a high- [1.5 minimum alveolar concentration (MAC)], moderate- (1.0 MAC), low- (0.5 MAC), or no- sevoflurane dose prior to CPB. Standard blood gas parameters, serum S-100 protein, and neuron-specific enolase (NSE) were measured at different time points. The mini-mental state examination (MMSE) was administered 1 day before and 24 and 72 h after surgery. The jugular bulb venous oxygen saturation (SjvO2) in the moderate- and high-dose groups at a nasopharyngeal temperature of 25-28 °C was significantly higher compared with the control group, while the arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2) were significantly reduced. The serum S-100 protein and NSE concentrations of the moderate- and high-dose groups at 1 and 6 h after the cessation of CPB were significantly lower than that of the control group. The 24 h postoperative MMSE scores of the moderate- and high-dose groups were significantly higher than those of the low-dose and control groups. An inhaled optimal concentration of sevoflurane may be beneficial for cerebral oxygen balance during CPB, and may ameliorate cognitive damage. However, the effect is dose-dependent.

Prognostic evaluation of bispectral index in patients following cardiopulmonary resuscitation

The aim of this study was to evaluate the prognosis of patients following cardiopulmonary resuscitation in an intensive care unit (ICU) using bispectral index (BIS) monitoring. The study was a prospective comparative study performed at the academic department of an ICU. A total of 33 adults who received cardiopulmonary resuscitation were enrolled and divided into the surviving and non-surviving groups according to their 7-day survival status. During their stay in the ICU, the BIS and arterial oxygen saturation (SaO2) levels of all the patients were continuously monitored. The neurological condition of the patients was measured according to the Glasgow coma scale (GCS). Acute physiological and chronic diseases were measured according to the acute physiology and chronic health evaluation II (APACHE II). SaO2 was monitored in all patients. The jugular bulb venous oxygen saturation (SjO2) levels were continuously monitored in 23 patients and the difference between the SaO2 and SjO2 values was used to indicate oxygen metabolism in the brain. The variables in the present study were compared between the 2 groups. The correlations between BIS values and GCS or APACHE II scores were analyzed. The BIS values were significantly higher in the surviving group than in the non-surviving group (P<0.01). The difference between the SaO2 and SjO2 was significant (P<0.01). There was a positive correlation between BIS values and GCS scores (r=0.821, P<0.01) and between BIS values and APACHE II scores (r=0.434, P<0.05). BIS values may be used to predict the post-resuscitative outcome of patients following cardiopulmonary resuscitation.

Notice of Retraction

The following article from Acta Anaesthesiologica Scandinavica "Haemodynamics and cerebral oxygenation during arthroscopic shoulder surgery in beach chair position under general anaesthesia" by Jeong H, Lee SH, Jang EA, Chung SS, Lee J, Yoo KY. Acta Anaesthesiol Scand. 56 (7): 872–9(August 2012). DOI: 10.1111/j.1399-6576.2012.02716.x. and published online on 10 May 2012 in Wiley Online Library (wileyonlinelibrary.com) has been retracted at the request of the Editor-in-Chief Lars S. Rasmussen by agreement with Blackwell Publishing Ltd. The retraction has been decided based on redundancy because very similar findings have been published in the following article: "Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia". Jeong H, Jeong S, Lim HJ, Lee J, Yoo KY. Anesthesiology; 116 (5): 1047–56 (May 2012) from the same institution. The two articles do not cite each other. The corresponding author has acknowledged that data from some patients appear in both articles and the study design was misrepresented.