Tendons are frequently used for reconstructive surgery. This includes palmaris longus, plantaris, the long extensors of the toes and fingers as well as the flexors of the fingers. The surgeon must base his or her selection of the donor tendon for grafting on what is needed, for example tendon size, length, and width. The most desirable tendons in reconstructive surgery are the palmaris longus and plantaris tendons. These two muscles are also considered to be the easiest tendons to harvest, and therefore they remain the ideal choices for plantaris,or tendon grafts. Apart from what is mentioned in the literature, questions remain such as: which characteristics do the palmaris longus and plantaris muscles possess that make them suitable for use as flaps or grafts in reconstructive surgery and; how can knowledge of the characteristics of these muscles improve reconstructive surgery in South Africa? The palmaris longus and plantaris muscles are indeed subject to variation, whether in the general anatomy, form, attachment, actions and/or prevalence. A statistical significant difference was found between the male and female sample when considering the length of the palmaris longus muscle. When comparing the palmaris longus muscle to the plantaris muscles, it was found that there is a statistical significant difference between them as well. Therefore, although these muscles may look alike, when it comes to the surgical aspect it is suggested that the palmaris longus is used when a wider tendon is preferred and the plantaris muscle when a longer tendon is needed. The prevalence of the palmaris longus and plantaris muscles compared well with studies done on other population groups. No correlation was found between the sex of the cadaver and the prevalence of the palmaris longus and plantaris muscles. In addition it was established that there is no relationship between the prevalence of the palmaris longus and plantaris muscles in the same individual. A possible phylogenetic degenerative trend for the palmaris longus muscle was also examined. After studying various age groups, it was determined that such a trend could not be established for this sample. In conclusion, based on the morphology and prevalence of the palmaris longus and plantaris muscles in a South African population, they are ideal for the use of flaps and/or tendon graft in reconstructive surgery. But it is of utmost importance that the reconstructive surgeon, working on South African patients, remember that both these muscles are subject to variation and not only will it be beneficial to employ proper detection methods to determine the viability of either muscle before considering its suitability in reconstructive surgery but also a sound knowledge of the anatomy of these muscles must be known. AFRIKAANS : Tendons word dikwels gebruik vir rekonstruktiewe chirurgie. Dit sluit die M. palmaris longus en M. plantaris, die lang ekstensors van die tone en vingers, sowel as die fleksors van die vingers in. Die chirurg moet sy of haar keuse van die skenkertendon baseer op dit wat benodig word, byvoorbeeld tendongrootte, ~lengte en ~breedte. Die mees gesogte tendons in rekonstruktiewe chirurgie is dié van M. palmaris longus en M. plantaris. Hierdie twee spiere word ook geag as die maklikste spiere om te oes / bekom, en daarom bly hulle die ideale keuse vir weefselsnitte of tendon-oorplantings. Afgesien van wat in die literatuur beskryf word, bly die volgende vrae onbeantwoord: Watter eienskappe maak M. palmaris longus en M. plantaris geskik vir die gebruik as weefselsnitte of tendon-oorplantings in rekonstruktiewe chirurgie en, hoe kan kennis van hierdie eienskappe van dié spiere, rekonstruktiewe chirurgie in Suid-Afrika verbeter? M. palmaris longus en M. plantaris is inderdaad onderworpe aan variasie van die algemene anatomie, vorm, aanhegtings, aksies en / of aanwesigheid en/of afwesigheid. 'n Statistiese beduidende verskil is gevind tussen die manlike en vroulike steekproef ten opsigte van die lengte van M. palmaris longus. M. palmaris longus is met M. plantaris ook vergelyk en daar was gevind dat daar 'n statisties beduidende verskil tussen hierdie spiere is. Alhoewel hierdie spiere dieselfde lyk, is dit belangrik om in ag te neem dat as dit by die chirurgiese aspekte kom, word daar voorgestel dat M. palmaris longus eerder gebruik moet word wanneer 'n wyer tendon verkies word en M. plantaris gekies moet word wanneer ‘n langer tendon benodig word. Daar is goeie ooreenkoms tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris wanneer hul met studies, wat op die ander bevolkingsgroepe gedoen was, vergelyk word. Geen ooreenkomste was tussen die geslag van die kadawer en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris gevind nie. Daarbenewens was dit vasgestel dat daar geen verhouding tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris in dieselfde individu is nie. 'n Moontlike filogenetiese degeneratiewe tendens vir M. palmaris longus is ook ondersoek. Na die bestudering van verskillende ouderdomsgroepe, is daar bepaal dat so 'n tendens nie bevestig kon word vir hierdie steekproef nie. Ter afsluiting, die morfologie en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris, in 'n Suid-Afrikaanse bevolking, is ideaal vir die gebruik van weefselsnitte of tendon-oorplantings in rekonstruktiewe chirurgie. Maar dit is van uiterste belang dat die rekonstruktiewe chirurg, wie met Suid-Afrikaanse pasiënte werk, onthou dat beide hierdie spiere onderworpe is aan variasie. Dit sal dus voordelig wees om behoorlike opsporingsmetodes te gebruik om die vatbaarheid van hierdie spiere in rekonstruktiewe chirurgie vas te stel, maar hy of sy het ook kennis van die anatomie van hierdie spiere, nodig. Copyright / Dissertation (MSc)--University of Pretoria, 2011. / Anatomy / unrestricted

Endovascular repair of popliteal artery aneurysms has been used with increasing frequency in recent years. Advocates of the procedure claim a lower rate of complications, early return to work, no change in the quality of life, and long-term patency rates that are as favorable as those following open surgical repair. Unfortunately, data of only 1 prospective randomized study are available, and a recent meta-analysis showed a higher rate of early graft thromboses and more early reinterventions after endograft repair of popliteal artery aneurysms. Open, elective surgical repair with the vein graft has patency rates more than 90% in contemporary series. Current evidence only supports the use of stent grafts in those with high surgical risks and in the elderly.

Introdução: A evolução das técnicas de rinoplastia está intimamente relacionada com o melhor conhecimento anatômico e funcional do nariz. A observação de que a incompetência das válvulas nasais pode ser responsável por até 50 por cento das queixas obstrutivas vem sendo confirmada através de diversos estudos. A utilização de enxertos expansores (spreader grafts) para ampliação das válvulas internas já foi bem estabelecida, no entanto, ainda não foi bem estudada de forma objetiva. Objetivo: A finalidade deste estudo foi avaliar prospectivamente a utilização de enxertos expansores na rinoplastia, fazendo-se uma análise objetiva do grau de melhora da patência nasal dos pacientes através da rinometria acústica e do espelho de Glatzel modificado, bem como uma análise subjetiva da qualidade de respiração dos mesmos pacientes mediante um escore preestabelecido. Metodologia: Foram estudados vinte pacientes submetidos à rinoplastia com utilização de enxertos expansores. Os pacientes foram avaliados no pré-operatório através de análise subjetiva através de questionário de qualidade respiratória - e objetiva, através de medidas da área de secção mínima transversa correspondente à válvula nasal interna mediante a rinometria acústica, e, através do espelho de Glatzel modificado. Após 90 a 120 dias da cirurgia, novas medidas foram realizadas, comparando-as com os resultados obtidos no pré-operatório. Os valores obtidos foram abordados sob a forma de variáveis quantitativas e analisados de acordo com a média e o desvio-padrão pelo teste não paramétrico de Wilcoxon. Conclusão: As medidas referentes às válvulas internas obtidas mediante rinometria acústica foram superiores quando comparados o momento pós-operatório com o pré-operatório dos lados direito e esquerdo. Quando analisados os valores obtidos através do espelho de Glatzel modificado, também observou-se que houve um acréscimo das médias se comparado o pós com o pré-operatório. A análise subjetiva da sensação de patência nasal demonstrou uma melhora na qualidade respiratória e apresentou significância estatística / Background: The evolution of rhinoplasty techniques is closely related to the best knowledge of anatomy and function of the nose. The observation that the nasal valve incompetence may be responsible for up to 50 percent of obstructive symptoms has been confirmed by several studies. Using spreader grafts for internal valves expansion has been well established; however, it has not been well studied objectively. Objective: The purpose of this study was to prospectively evaluate the use of spreader grafts during rhinoplasty. We analyzed objectively the improvement degree in the nasal patency of patients through acoustic rhinometry and modified Glatzels mirror. We also analyzed the subjective improvement degree through a breathing quality score. Method: We studied twenty patients undergoing rhinoplasty with spreader grafts. Patients were evaluated preoperatively through subjective means-by a quality in breathing questionnaire-and objective analysis, by measuring the minimum cross sectional area (corresponding to the internal nasal valve) by acoustic rhinometry and through a modified Glatzels mirror. After 90 to 120 days, new measurements were made and then compared with those obtained preoperatively. The values were addressed in the form of quantitative variables and analyzed according to the mean and standard deviation by the nonparametric Wilcoxon test. Conclusion: The measures relating to the internal valves obtained by acoustic rhinometry were higher when the moment after surgery was compared with the preoperative moment on the left and the right sides. The results obtained by the modified Glatzels mirror also showed an increase in the measures in both sides. Analysis of subjective sensation of nasal patency demonstrated an improvement in quality of breathing with statistical significance

No description available.

Submitted by RAFAEL ROVERI SABIÃO null (rrsabiao@yahoo.com.br) on 2016-04-18T18:42:09Z No. of bitstreams: 1 Tese Rafael Roveri Sabião.pdf: 2541381 bytes, checksum: 3e09347a4b40e6f47b0edbebccd7c931 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-19T16:43:08Z (GMT) No. of bitstreams: 1 sabiao_rr_dr_jabo.pdf: 2541381 bytes, checksum: 3e09347a4b40e6f47b0edbebccd7c931 (MD5) / Made available in DSpace on 2016-04-19T16:43:08Z (GMT). No. of bitstreams: 1 sabiao_rr_dr_jabo.pdf: 2541381 bytes, checksum: 3e09347a4b40e6f47b0edbebccd7c931 (MD5) Previous issue date: 2016-02-26 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / O pessegueiro vem ganhando espaço em regiões produtoras de frutas do estado de São Paulo, principalmente as cultivares de baixo requerimento de frio, como o ‘Aurora-1’. O umezeiro é um portaenxerto que condiciona menores volumes de copa em plantas de pessegueiro, além de possuir resistência a patógenos de solo, sendo objeto de estudo neste trabalho, avaliando-se sua clonagem por estaquia, além de sua combinação com o ‘Aurora-1’, por enxertia de mesa, e enraizamento simultâneo. Em ambos os trabalhos foram utilizadas as concentrações 0; 1.000; 3.000 e 5.000 mg/L de AIB para tratamento das estacas, que foram coletadas em duas situações de vegetação da planta de umezeiro: estacas herbáceas retiradas da planta adulta e estacas herbáceas retiradas da planta após 60 dias da poda de rejuvenescimento. Foram avaliados: porcentagem de sobrevivência, com folhas, calos e enraizamento das estacas, número e comprimento médio de raízes e porcentagem de enxertos vivos e com estacas enraizadas. Também foi realizado um estudo histológico, por microscopia eletrônica de varredura, das regiões de rizogênese e de contato e união da enxertia. Os materiais vegetativos propagados apresentaram melhores resultados depois de uma poda rejuvenescimento. A estaquia teve superioridade em todas as variáveis avaliadas em comparação à enxertia de mesa. O ‘Rigitano’ apresentou melhores resultados, sendo superado pelo Clone 15 apenas na sobrevivência dos enxertos. O uso de AIB influenciou na sobrevivência e no enraizamento das estacas e incrementou o número médio de raízes por estaca. / The peach tree is becoming more popular in fruit producing regions of São Paulo, mainly cultivars with low chill requirement, such as 'Aurora-1'. The japanese apricot, as being a rootstock that conditions smallest canopy in peach plants, besides having resistance to soil pathogens, being object of this work, evaluating their cloning by cuttings and their combination in grafting with simultaneous rooting, with the 'Aurora-1'. In both studies was used the concentrations 0; 1,000; 3,000 and 5000 mg/L of IBA in two vegetation situations of mume plant: softwood cuttings taken from adult plants and softwood cuttings taken from the plant after 60 days of rejuvenation pruning. It was evaluated the rooting percentage parameters of cuttings, number and average length of roots and percentage of survival of grafts with rooting cuttings. It was also conducted a histological study, by scanning electron microscopy, of the root formation zone and contact grafting. The vegetative material propagated showed better results after a rejuvenation pruning. The cuttings had superiority in all variables evaluated, in comparison to the cuttings grafted. The 'Rigitano' had the best results, being overcome by Clone 15 only in the survival of grafts. The IBA concentrations influenced the survival and rooting of cuttings and the use of IBA increased the average number of roots of cutting. / CNPq: 140598/2013-8

Introdução: A evolução das técnicas de rinoplastia está intimamente relacionada com o melhor conhecimento anatômico e funcional do nariz. A observação de que a incompetência das válvulas nasais pode ser responsável por até 50 por cento das queixas obstrutivas vem sendo confirmada através de diversos estudos. A utilização de enxertos expansores (spreader grafts) para ampliação das válvulas internas já foi bem estabelecida, no entanto, ainda não foi bem estudada de forma objetiva. Objetivo: A finalidade deste estudo foi avaliar prospectivamente a utilização de enxertos expansores na rinoplastia, fazendo-se uma análise objetiva do grau de melhora da patência nasal dos pacientes através da rinometria acústica e do espelho de Glatzel modificado, bem como uma análise subjetiva da qualidade de respiração dos mesmos pacientes mediante um escore preestabelecido. Metodologia: Foram estudados vinte pacientes submetidos à rinoplastia com utilização de enxertos expansores. Os pacientes foram avaliados no pré-operatório através de análise subjetiva através de questionário de qualidade respiratória - e objetiva, através de medidas da área de secção mínima transversa correspondente à válvula nasal interna mediante a rinometria acústica, e, através do espelho de Glatzel modificado. Após 90 a 120 dias da cirurgia, novas medidas foram realizadas, comparando-as com os resultados obtidos no pré-operatório. Os valores obtidos foram abordados sob a forma de variáveis quantitativas e analisados de acordo com a média e o desvio-padrão pelo teste não paramétrico de Wilcoxon. Conclusão: As medidas referentes às válvulas internas obtidas mediante rinometria acústica foram superiores quando comparados o momento pós-operatório com o pré-operatório dos lados direito e esquerdo. Quando analisados os valores obtidos através do espelho de Glatzel modificado, também observou-se que houve um acréscimo das médias se comparado o pós com o pré-operatório. A análise subjetiva da sensação de patência nasal demonstrou uma melhora na qualidade respiratória e apresentou significância estatística / Background: The evolution of rhinoplasty techniques is closely related to the best knowledge of anatomy and function of the nose. The observation that the nasal valve incompetence may be responsible for up to 50 percent of obstructive symptoms has been confirmed by several studies. Using spreader grafts for internal valves expansion has been well established; however, it has not been well studied objectively. Objective: The purpose of this study was to prospectively evaluate the use of spreader grafts during rhinoplasty. We analyzed objectively the improvement degree in the nasal patency of patients through acoustic rhinometry and modified Glatzels mirror. We also analyzed the subjective improvement degree through a breathing quality score. Method: We studied twenty patients undergoing rhinoplasty with spreader grafts. Patients were evaluated preoperatively through subjective means-by a quality in breathing questionnaire-and objective analysis, by measuring the minimum cross sectional area (corresponding to the internal nasal valve) by acoustic rhinometry and through a modified Glatzels mirror. After 90 to 120 days, new measurements were made and then compared with those obtained preoperatively. The values were addressed in the form of quantitative variables and analyzed according to the mean and standard deviation by the nonparametric Wilcoxon test. Conclusion: The measures relating to the internal valves obtained by acoustic rhinometry were higher when the moment after surgery was compared with the preoperative moment on the left and the right sides. The results obtained by the modified Glatzels mirror also showed an increase in the measures in both sides. Analysis of subjective sensation of nasal patency demonstrated an improvement in quality of breathing with statistical significance

For a considerable number of years the problem of revascularizing the myocardium after the development of coronary circulatory deficiency has stirred the imagination of physiologists, clinicians and surgeons. The obstruction in the coronary system brings a reduction in the coronary blood flow which is responsible for the symptoms and deterioration of the myocardial function In hearts otherwise normal or close to a standard normal state.

No description available.

Introduction The long-term patency of the grafts used during the coronary artery bypass grafting (CABG) is one of the most significant predictors of the clinical outcomes. The gold standard graft used during CABG with the best long-term patency rate and the better clinical outcomes is left internal thoracic artery (LITA) grafted to the left coronary artery (LCA). The controversy lies in choosing the second-best conduit for the non-left coronary artery (NLCA) with similar patency rate as LITA. This meta-analysis examines the long-term patency and clinical outcomes of all arterial grafts versus all venous grafts used during the CABG. Methods A comprehensive literature search of all published randomized control trials (RCTs) assessing long-term patency and clinical outcomes of grafts used in CABG was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966-2018). Keywords searched included combinations of "CABG", "venous grafts in CABG", "arterial grafts in CABG", "radial artery grafts in CABG", "gastroepiploic artery grafts in CABG", "patency and clinical outcomes". Inclusion criteria included: RCTs comparing the long-term patency, and clinical outcomes of radial artery, right internal thoracic artery, gastroduodenal artery, and saphenous vein grafts used in CABG. Long-term patency of the grafts and clinical outcomes were analyzed. Results Eight RCTs involving 2,091 patients with 1,164 patients receiving arterial grafts and 927 patients receiving venous grafts were included. There was no difference between the long-term patency rate (relative risk (RR) = 1.050, 95% confidence interval (CI) = 0.949 to 1.162, and p = 0.344), overall mortality rate (RR = 1.095, 95% CI = 0.561 to 2.136, and p = 0.790), rate of myocardial infarction (MI) (RR = 0.860, 95% CI = 0.409 to 1.812, and P = 0.692), and re-intervention rate (RR = 0.0768, 95% CI = 0.419 to 1.406, and P = 0.392) between arterial and venous grafts. Conclusion The use of arterial conduits over the venous conduits has no significant superiority regarding the long-term graft patency, the rate of MI, overall mortality, and the rate of revascularization following CABG. Additional adequately powered studies are needed to further evaluate the long-term outcomes of arterial and venous grafts following the CABG.

Submitted in partial fulfilment of the requirements for the Degree of Doctor of Technology: Clinical technology, Durban University of Technology, 2011. / Surgical revascularization of the coronary arteries is a cornerstone of cardiothoracic surgery. The enduring nature of coronary artery bypass grafting (CABG) bespeaks of its history and proven efficacy. However, cerebral deoxygenation during on-pump coronary artery bypass graft surgery may be associated with adverse neurological sequelae. Advanced age and the incidence of preoperative co-morbidity in patients presenting for coronary artery bypass graft surgery increases the potential for stroke and other adverse perioperative outcomes (Murkin, Adams, Quantz, Bainbridge and Novick, 2007). It is hypothesized, that by using the brain as an index organ, interventions to improve cerebral oxygenation would have systemic benefits for cardiac surgical patients. In an attempt to predict those patients that are predisposed to cerebral complications, investigators have used neurological monitoring ie, Near infrared spectroscopy (NIRS) to enhance detection of hypoxic conditions associated with neurological injury (Hoffman, 2006). Serum S100B protein has been used as a biochemical marker of brain injury during cardiac surgery. Elevated levels serve as a potential marker of brain cell damage and adverse neurological outcomes (Einav, Itshayek, Kark, Ovadia, Weiniger and Shoshan, 2008). Aims and Objectives of the study This prospective, quantitative, interventional study was carried out to maintain cerebral tissue oxygen saturation during cardiopulmonary bypass above 75% of the baseline level by implementation of a proposed interventional protocol. The analysis of S100B which is a marker of neurological injury and optimization of regional cerebral oxygen saturation would allow for the formulation of an algorithm which could be implemented during on-pump coronary artery bypass graft surgery as a preventive clinical measure further reducing the risk of neurological injury. Central venous lines (CVP) are inserted routinely during cardiac surgery. Central venous oxygen saturation is a global marker of tissue oxygenation. A secondary aim of the study was to determine if a correlation existed between central venous and cerebral tissue oxygen saturations. If a positive correlation existed then central venous oxygen saturation could be used as a surrogate measure of cerebral tissue oxygen saturation during on-pump coronary artery bypass graft surgery. This study is one of the first done in the South African population group. Methods Forty (40) patients undergoing on-pump coronary artery bypass graft surgery were recruited at Inkosi Albert Luthuli Central Hospital. Patients were randomized into a control group (n=20) and interventional group (n=20) using a sealed envelope system. The envelope contained designation to either group. Envelopes were randomly chosen. Intraoperative regional cerebral oxygen saturation (rSO2 ) monitoring with active display and treatment intervention protocol was administered for the interventional group. In the control group regional cerebral oxygen saturation monitoring was not visible to the perfusionist operating the heart lung machine during cardiopulmonary bypass (blinded). Recording of regional cerebral saturation was conducted by an independent person (another perfusionist) who was not involved in the management of the case so as to ensure that no interventions were carried out on the control group. Arterial blood samples for the measurement of serum S100B were taken pre and postoperatively. An enzyme immunoassay (ELISA) was used for the quantitative and comparative measurement of human S100B concentrations for both groups. Central venous oxygen saturation was monitored from the CVP using the Edwards Vigileo monitor. Cerebral monitoring constituted the use of Near infrared spectroscopy monitoring using the Invos 5100c, Somonetics Corp, Troy MI monitor. Adhesive optode pads were be placed over each fronto- temporal area for cerebral oxygen measurement. During cardiopulmonary bypass, eight time period measurements of mean arterial pressure (MAP), heart rate, temperature, activated clotting time (ACT), patient oxygen saturation (SpO2), partial pressure of carbon dioxide (pCO2), haematocrit, lactate, pH, haemoglobin (Hb), base excess (BE), potassium (K+), sodium (Na+), glucose, calcium (Ca2+), central venous oxygen saturation (ScvO2), cerebral tissue oxygen saturation (rSO2), fraction inspired oxygen (FiO2 ), sweep rate, pump flow rate (cardiac index), and percentage isoflurane per patient were taken. The time periods when data was recorded included: 5 minutes after onset of cardiopulmonary bypass, aortic cross clamping, after cardioplegic arrest, during distal anastomosis, during proximal anastomosis, during rewarming, after aortic cross clamp release and before termination of cardiopulmonary bypass. Baseline measurements were also taken. Clinical data recorded for both groups included: the number of grafts performed, cardiopulmonary bypass time, cross clamp time, red blood cells administered (packed cells), amount of adrenalin infused and total cerebral desaturation time. A prioritized intraoperative management protocol to maintain rSO2 values above 75% of the baseline threshold during cardiopulmonary bypass was followed. Cerebral desaturation was defined as a decrease in saturation values below 70% of baseline for more than one minute. Interventions commenced within 15 seconds of decrease below 75% of baseline value. Results The results of the study show that there was a highly significant difference in the change in S100B concentrations pre and post surgery between the interventional and control groups. The intervention vii group showed a smaller increase in S100B concentration of 37.3 picograms per millilitre (pg/ml) while the control group showed a larger increase of 139.3 pg/ml. Therefore, the control group showed a significantly higher increase in S100B concentration over time than the intervention group (p < 0.001). Maximizing pump flow rates was the most common intervention used (45 times) followed by maintaining partial pressure of carbon dioxide to approximately 40 mmHg (28 times), increasing mean arterial pressure by administration of adrenalin (11 times) and administration of red blood cells to increase haematocrit (11 times). There was a highly statistically significant treatment effect within the intervention group for each of the above interventions compared with no intervention. The above mentioned interventions significantly affected right and left cerebral oxygen saturations. However, administration of red blood cells was not found to significantly increase right (p = 0.165) and left (p = 0.169) cerebral oxygen saturation within the intervention group. The study highlighted a significant difference between the intervention and control groups in terms of cerebral desaturation time (p <0.001). The mean desaturation time for the control group was 63.85 minutes as compared to 24.7 minutes in the interventional group. Cerebral desaturation occurred predominantly during aortic cross clamping, distal anastomosis of coronary arteries and aortic cross clamp release. Predictors of cerebral oxygen desaturation included, partial pressure of carbon dioxide (pCO2), temperature, pump flow rate (LMP), mean arterial pressure (MAP), haematocrit, heart rate (HR) and patient oxygen saturation (SpO2). Central venous oxygen saturation was not significantly related to right (p = 0.244) or left (p = 0.613) cerebral oxygen saturations. Therefore central venous oxygen saturation cannot be used as a surrogate measure of cerebral tissue oxygen saturation during on-pump coronary artery bypass graft surgery. viii Conclusion These findings demonstrate the positive effect of optimizing cerebral oxygen saturation using an interventional protocol on markers of neurological injury (S100B). Optimization of pump flow rate, partial pressure of carbon dioxide and mean arterial pressure would result in increased cerebral oxygen saturation levels and a reduction in neurological injury. Therefore, an algorithm incorporating these interventions can be formulated. Monitoring specifically for brain oxygen saturation together with an effective treatment protocol to deal with cerebral desaturation during on-pump CABG must be advocated.