[Monitoring of jugular venous oxygen saturation during superficial temporal artery-middle cerebral artery anastomosis under intraaortic balloon pumping: a case report].

A 77-year-old man scheduled for coronary artery bypass grafting underwent left superficial temporal artery-middle cerebral artery anastomosis (STA MCA). Before anesthesia, we planned to insert an intraaortic balloon pump as a perioperative circulatory assist. In addition, a fiberoptic catheter was inserted in the proximity of the right jugular bulb to monitor jugular venous oxygen saturation (Sjv(O2)) as an index of the balance between cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2). Continuous infusion of nicorandil was started prior to induction of anesthesia. General anesthesia was induced with remifentanil, propofol and rocuronium, and was maintained with oxygen, air, remifentanil and propofol. After induction of anesthesia, blood pressure decreased from 160/70 mmHg to 100/50 mmHg. There was no abnormality of electrocardiogram. However, Sjv(O2) decreased from 58% to 40%. Ephedrine was immediately injected and continuous infusion of dopamine was started. Blood pressure increased and Sjv(O2) was improved to > 55%. Thereafter, his operative course was uneventful. Sjv(O2) is normally approximately 55-75%. If Sjv(O2) is < 50%, therapy (s) directed at increasing CBF and/or decreasing CMRO2 should be initiated. Sjv(O2) monitoring can be used to determine the minimal blood pressure that should be maintained to avoid cerebral ischemia in the case of STA-MCA.