• Chanchal Bhandari, Hemang Gandhi, Anil Panwar, Maruti Haranal, and Himani Pandya.
• Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center (affiliated with B. J. Medical College), New Civil Hospital Campus, Asarwa, Ahmedabad. Electronic address: drhemang77@yahoo.co.in.
• J. Cardiothorac. Vasc. Anesth. 2024 Mar 6.

Objective And DesignA single-center prospective randomized controlled study was conducted to assess the effect of targeted mild hypercapnia (TMH) on cerebral oxygen saturation (rSO2) in patients undergoing off-pump coronary artery bypass grafting (CABG).Setting And ParticipantsA prospective randomized controlled study involving 100 patients undergoing off-pump CABG at U. N. Mehta Hospital, Ahmedabad, Gujarat, India.InterventionPatients were randomized to either the TMH (PaCO2 45-55 mmHg) or the targeted normocapnia (TN; PaCO2 35-45 mmHg) group, containing 50 patients in each group.MeasurementsMonitoring of rSO2, heart rate, mean arterial pressure (MAP), PaCO2, and peripheral oxygen saturation was done at baseline, after induction, after left internal mammary artery harvesting, at each grafting (distal and proximal), after protamine, and after shifting to the intensive care unit. The standardized minimental-state examination (SMMSE) was performed preoperatively and at 8, 12, and 24 hours postextubation. Data were analyzed using an independent sample t test.ResultsThe TMH group had higher MAP during grafting (p < 0.001) and higher rSO2 on both sides during distal and proximal grafting (p < 0.001) and after protamine (p < 0.05), as compared to the TN group. Compared to preoperative values, SMMSE scores in the TN group were significantly lower at 12 and 24 hours postextubation (p < 0.001).ConclusionTMH during grafting increased the cerebral blood flow and rSO2 when hemodynamic instability was very common. It has a protective role on the brain and helps maintain cognition postoperatively.Copyright © 2024 Elsevier Inc. All rights reserved.

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