The Effect of Diabetes on the Interrelationship Between Jugular Venous Oxygen Saturation Responsiveness to Phenylephrine Infusion and Cerebrovascular Carbon Dioxide Reactivity
- Yuji Kadoi, MD*,
- Shigeru Saito, MD†,
- Fumio Goto, MD† and
- Nao Fujita, MD‡
- Departments of *Intensive Care and
- †Anesthesiology, Gunma University, Graduate School of Medicine; and
- ‡Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center and Keiyu Orthopedic Hospital, Japan
- Address correspondence and reprint requests to Yuji Kadoi, MD, Department of Intensive Care, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. Address e-mail to kadoi{at}med.gunma-u.ac.jp
Abstract
In this study, we examined whether cerebrovascular carbon dioxide (CO2) reactivity was related to the response of jugular venous oxygen saturation (SjvO2) to phenylephrine infusion in diabetic patients during cardiopulmonary bypass. Forty diabetic patients scheduled for coronary artery bypass graft surgery were studied, and 40 age-matched nondiabetic cardiopulmonary bypass patients served as controls. Cerebrovascular CO2 reactivity was measured continuously using transcranial Doppler. Mean arterial blood pressure (MAP) was increased by repeated phenylephrine infusion until reaching 100% of baseline values. There was a significant difference in absolute CO2 reactivity between the diabetic and control groups (controls, 2.8 ± 0.7 cm · s−1 · mm Hg−1; diabetics, 2.2 ± 1.1 cm · s−1 · mm Hg−1; P = 0.02). Among the diabetics, absolute CO2 reactivity in insulin-dependent patients was less than that in noninsulin-dependent patients (diet therapy group, 3.2 ± 0.7; glibenclamide group, 2.6 ± 0.7; insulin-dependent group, 1.0 ± 0.7; P < 0.01). There was a correlation between absolute CO2 reactivity and the mean slope of SjvO2 versus MAP for increasing MAP (r = 0.54; P < 0.0001). In conclusion, we found that the interrelationship between SjvO2 responsiveness to phenylephrine infusion and cerebrovascular CO2 reactivity, as well as impaired cerebrovascular autoregulation, were associated with previous hyperglycemia.
Abstract
IMPLICATIONS: We examined whether the interrelationship between jugular venous oxygen saturation responsiveness to phenylephrine infusion and cerebrovascular CO2 reactivity, as well as impaired cerebrovascular autoregulation, were associated with previous hyperglycemia.
Footnotes
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- Accepted March 3, 2004.