Changes of Cerebral Oxygenation in Sequential Glenn and Fontan Procedures in the Same Children

Yagi, Yuki; Yamamoto, Misazō; Saitô, Hitoshi; Mori, Toshihiro; Morimoto, Yuji; Oyasu, Takayoshi; Tachibana, Tsuyoshi; Ito, Yoichi M.

doi:10.1007/s00246-017-1647-0

Cited by 16 publications

(8 citation statements)

References 16 publications

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“…Bradely et aldemonstrated that hypoventilation improves cerebral blood flow velocity in infants with bidirectional superior cavopulmonary connection [24], and rSCO 2 was associated with the change of cerebral blood perfusion [25]. In this study, we found increase of rSCO 2 in accordance of increase of PaCO 2 .…”

Section: Discussionsupporting

confidence: 71%

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

Zeng

Wei

et al. 2019

BMC Anesthesiol

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Background Increase of pulmonary vascular resistance (PVR) is an efficient method of modulating pulmonary and systemic blood flows (Qp/Qs) for patients with left-to-right (L-R) shunt, and is also closely associated with insufficient oxygen exchange for pulmonary hypoperfusion. So that it might be a preferred regime of maintaining arterial partial pressure of carbon dioxide tension (PaCO2) within an optimal boundary via ventilation management in congenital heart disease (CHD) patients for the inconvenient measure of the PVR and Qp/Qs. However, the appropriate range of PaCO2 and patient-specific mechanical ventilation settings remain controversial for CHD children with L-R shunt. Methods Thirty-one pediatric patients with L-R shunt, 1–6 yr of age, were included in this observation study. Patients were ventilated with tidal volume (VT) of 10, 8 and 6 ml/kg in sequence, and 15 min stabilization period for individual VT. The velocity time integral (VTI) of L-R shunt, pulmonary artery (PA) and descending aorta (DA) were measured with transesophageal echocardiography (TEE) after an initial 15 min stabilization period for each VT, with arterial blood gas analysis. Near-infrared spectroscopy sensor were positioned on the surface of the bilateral temporal artery to monitor the change in regional cerebral oxygen saturation (rScO2). Results PaCO2 was 31.51 ± 0.65 mmHg at VT 10 ml/kg vs. 37.15 ± 0.75 mmHg at VT 8 ml/kg (P < 0.03), with 44.24 ± 0.99 mmHg at VT 6 ml/kg significantly higher than 37.15 ± 0.75 mmHg at VT 8 ml/kg. However, PaO2 at a VT of 6 ml/kg was lower than that at a VT of 10 ml/kg (P = 0.05). Meanwhile, 72% (22/31) patients had PaCO2 in the range of 40-50 mmHg at VT 6 ml/kg. VTI of L-R shunt and PA at VT 6 ml/kg were lower than that at VT of 8 and 10 ml/kg (P < 0.05). rScO2 at a VT of 6 ml/kg was higher than that at a VT of 8 and 10 ml/kg (P < 0.05), with a significantly correlation between rScO2 and PaCO2 (r = 0.53). VTI of PA in patients with defect diameter > 10 mm was higher that that in patients with defect diameter ≤ 10 mm. Conclusions Maintaining PaCO2 in the boundary of 40-50 mmHg with VT 6 ml/kg might be a feasible ventilation regime to achieve better oxygenation for patients with L-R shunt. Continue raising PaCO2 should be careful. Trail registration Clinical Trial Registry of China (http://www.chictr.org.cn) identifier: ChiCTR-OOC-17011338, prospectively registered on May 9, 2017.

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Section: Discussionsupporting

confidence: 71%

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

Zeng

Wei

et al. 2019

BMC Anesthesiol

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“…It is reported that ScO 2 can be expressed as a function of SaO 2 , blood Hb, CBF and the cerebral metabolic rate for oxygen 16 . In our study, SpO 2 values (substituted for SaO 2 ) were stable throughout the observed period.…”

Section: Discussionsupporting

confidence: 58%

“…It became 99% at T4 and increased to 100% after T6 until T14, probably due to oxygenation after the spinal anesthesia. Although there was a significant difference in the Friedman test ( p < 0.01), these changes were small and might not have affected the changes in ScO 2 and Vm according to the physiological relationship between SaO 2 and these values 9,16 …”

Section: Resultsmentioning

confidence: 95%

Changes of cerebral oxygenation indices measured by near infrared time‐resolved spectroscopy during spinal anesthesia for cesarean section: Simultaneous measurement with cerebral blood flow

Itosu

Kubo

Morikawa

et al. 2021

J of Obstet and Gynaecol

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Aim To measure the changes in cerebral oxygenation indices by near infrared time‐resolved spectroscopy and the cerebral blood flow simultaneously after spinal anesthesia for cesarean section. Methods This prospective observational study was conducted for 25 pregnant women scheduled for elective cesarean section under spinal anesthesia. During a period of 15 min after spinal anesthesia, cerebral oxygenation (ScO2), and the total cerebral hemoglobin concentration (tHb) were measured using near infrared time‐resolved spectroscopy and mean cerebral blood flow velocity (Vm) was measured using transcranial Doppler ultrasonography. Next, in the women who had nausea during the observed period, we compared these values when nausea was detected with those when it was not. Results Mean arterial pressure (MAP) decreased to around 60 mmHg (by 25% compared to the control) 6 min after spinal anesthesia. Compared to the control, ScO2 decreased by about 3% after 6 min and then gradually increased. The tHb, which reflects cerebral blood volume started to decrease just after spinal anesthesia and this continued until 12 min (the decrease was about 12%). Vm decreased by about 7%. In the 14 women who had nausea, MAP, Vm, and ScO2 values when nausea was detected were significantly lower than when it was not. Conclusion The changes in cerebral hemodynamics may be small after spinal anesthesia in ordinary cesarean section compared to the reduction of systemic arterial blood pressure. There might be greater decreases in cerebral blood flow and oxygenation when nausea occurred in the pregnant women who experienced it after spinal anesthesia.

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“…Another issue to be considered is that we used an adult sensor to measure the rSO 2 value. Although standard values of rSO 2 vary depending on the type of sensor used [13,14], they are enough to be trustworthy [6,7]. In this case, we did not check bilateral brain saturation, but monitoring of RRBP and SpO 2 on the left hand provided us enough information.…”

Section: Discussionmentioning

confidence: 96%

Early detection of cerebral ischemia due to pericardium traction using cerebral oximetry in pediatric minimally invasive cardiac surgery: a case report

et al. 2019

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Background: Minimally invasive cardiac surgery (MICS) for simple congenital heart defects has become popular, and monitoring of regional cerebral oxygen saturation (rSO 2) is crucial for preventing cerebral ischemia during pediatric MICS. We describe a pediatric case with a sudden decrease in rSO 2 during MICS. Case presentation: An 8-month-old male underwent minimally invasive ventricular septal defect closure. He developed a sudden decrease in rSO 2 and right radial artery blood pressure (RRBP) without changes in other parameters following pericardium traction. The rSO 2 and RRBP immediately recovered after removal of pericardium fixation. Obstruction of the right innominate artery secondary to the pericardium traction would have been responsible for it. Conclusions: Pericardium traction, one of the common procedures during MICS, triggered rSO 2 depression alerting us to the risk of cerebral ischemia. We should be aware that pericardium traction during MICS can lead to cerebral ischemia, which is preventable by cautious observation of the patient.

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Changes of Cerebral Oxygenation in Sequential Glenn and Fontan Procedures in the Same Children

Cited by 16 publications

References 16 publications

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

Changes of cerebral oxygenation indices measured by near infrared time‐resolved spectroscopy during spinal anesthesia for cesarean section: Simultaneous measurement with cerebral blood flow

Early detection of cerebral ischemia due to pericardium traction using cerebral oximetry in pediatric minimally invasive cardiac surgery: a case report

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