British Journal of Anaesthesia, Vol 75, Issue 5 527-530, Copyright © 1995 by The Board of Management and Trustees of the British Journal of Anaesthesia
E. Moss, N. M. Dearden and J. C. Berridge
Twenty-six patients requiring clipping of cerebral aneurysms were
anaesthetized with propofol, alfentanil and atracurium infusions and their
lungs ventilated mechanically to hypocapnia (3.4-4.5 kPa). SjO2 was
measured continuously with an Oximetrix fibreoptic oximetry catheter.
Normovolaemia was maintained by observing the response of mean arterial
pressure (MAP) and central venous pressure (CVP) to fluid administration.
The response of SjO2 to increased MAP was noted and the lactate oxygen
index (LOI) calculated at regular intervals. SjO2 measurements indicated a
critical MAP of between 80 and 110 mm Hg in nine patients, and one patient
had a persistently low SjO2 value despite an MAP of 110 mm Hg. An increase
in MAP was associated with an increase in SjO2 in 19 patients (P <
0.001). When the effects of changes in PaCO2 were eliminated, this change
was still significant (P = 0.004) (n = 9). Patients with an LOI > 0.08
at any time during the procedure had a worse initial outcome (within the
first day) (P < 0.02) than patients who had a normal LOI throughout.
Long-term outcome was similar to those with a normal LOI. Increasing MAP
did not have a consistent effect on LOI. Jugular bulb cannulation to assess
hypoperfusion in conjunction with lactate measurements and calculation of
LOI provide useful information on which to base the intra- and
postoperative management of patients with subarachnoid haemorrhage.
CLINICAL INVESTIGATIONS
Effects of changes in mean arterial pressure on SjO2 during cerebral aneurysm surgery
Department of Anaesthetics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX
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