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• W4235553742 abstract "Introduction. Oxygen desaturation and microembolization have both been implicated in the genesis of neurologic dysfunction following myocardial revascularization. Therefore, we examined their relative contribution to one aspect of brain injury using non-invasive near-infrared cerebral oximetry and transcranial Doppler ultrasound (TCD). Methods. Frontal lobe percent cerebrovenous oxygen saturation (CVOS) and the aggregate emboliform ultrasonic high-intensity transient signals (HITS) in the left middle cerebral artery were recorded continuously in 308 CABG patients from endotracheal intubation to sternal closure. On the fourth post-operative day, patient inability to perform anti-saccadic eye movements (10 trials/patient) was tested to provide a simple but sensitive and objective clinical measure of frontal lobe injury. [1,2] This test required voluntary lateral eye movement away from a target stimulus. The evaluator was blinded to intraoperative results. Results. Neurologic complications resulting in head CT with neurologist or psychiatrist consultation occurred in 17/73 patients having absent (0/10) anti-saccadic performance compared with 1/150 patients with intact (10/10 trials) performance (P<.001). Frontal lobe injury occurred in significantly (contingency (Table 1) analysis; P<.001) more patients with episodes of marked desaturation (CVOS<41%) compared with those having no desaturation (CVOS >50%). Kruskal-Wallis ANOVA indicated no association between HITS and frontal lobe injury. The sample sizes were sufficiently large to make these statistical inferences valid.Table 1: Relationships among CVOS, HITS and Frontal Lobe InjuryDiscussion. Obvious neurologic complications occurred significantly more often in patients unable to perform anti-saccadic eye movements. Despite its subtle nature, this sign of frontal lobe injury appears to have considerable economic implications. The evidence of frontal lobe injury was associated with cerebrovenous oxygen desaturation but was unrelated to ultrasonic evidence of cerebral microembolization. Residual anesthetic or analgesic effects are an unlikely explanation for the high incidence of eye movement deficits in the marked desaturation group, since pharmacologic suppression should have been equally distributed among the three CVOS groups. These results suggest that efforts to prevent or correct cerebral oxygen desaturation may help to reduce both neurologic complications and the costs associated with myocardial revascularization." @default.
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• W4235553742 date "1998-04-01" @default.
• W4235553742 modified "2023-09-27" @default.
• W4235553742 title "CEREBRAL OXYGEN DESATURATION DURING MYOCARDIAL REVASCULARIZATION IS ASSOCIATED WITH FRONTAL LOBE INJURY" @default.
• W4235553742 doi "https://doi.org/10.1213/00000539-199804001-00013" @default.
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