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Abstract

Central haemodynamics, peripheral tissue perfusion and blood lactate concentration were studied in eight male patients undergoing coronary artery bypass grafting, being operated upon under moderate haemodilution and systemic hypothermia. Peripheral tissue perfusion was assessed by continuous recordings of subcutaneous tissue PO₂ (P_scO₂), skin red cell flux (RCF) and transcutaneous PO₂ (P_tcO₂) in the upper extremity. P_tcO₂ index (= P_tcO₂/arterial PO₂) was determined and finger-tip temperature (Tft) serially measured. PaO₂ and P_tcO₂ reached maximum values during the extracorporeal circulation (ECC) at the deepest hypothermia, whereas P_scO₂, P_tcO₂ index, RCF and Tft decreased markedly during ECC, rose during rewarming and fell again towards the end of surgery. Lactate accumulated in the blood especially after coming off bypass. These data suggest that the patients develop hypoperfusion and hypoxia of the peripheral tissues during extracorporeal circulation and again at the end of operation despite seemingly adequate central haemodynamics. This is possibly caused by the cooling and vasoconstriction of the peripheral vascular bed.

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Peripheral tissue perfusion during coronary artery bypass grafting

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