Cerebral oxygenation during paediatric cardiac surgery: identification of vulnerable periods using near infrared spectroscopy

ABSTRACT Objective Neurologic sequelae remain a well-recognized complication of pediatric cardiac surgery. The aetiology of neurologic injury is almost certainly multifactorial, imbalance between cerebral oxygen supply and demand is likely to play an important role. We sought to measure regional cerebral oxygenation in children undergoing cardiac surgery using nearinfrared spectroscopy to ascertain such vulnerable periods. Materials and methods This study is an observational study of 18 children (median age 1.3 years) undergoing cardiac surgery. Regional cerebral oxygenation was monitored using the INVOS3100 cerebral oximeter and related to hemodynamic parameters at each stage of the procedure. Results Prior to the onset of bypass, 10 patients had a decrease in regional cerebral oxygenation, reaching a saturation less than 35% in 5 cases. The most common cause was handling and dissection around the heart prior to and during caval cannulation. With institution of bypass, regional cerebral oxygenation increased. Discontinuation of bypass caused a precipitous decrease in regional cerebral oxygenation in three patients, reaching less than 40%. Conclusions These observations suggest that the pre- and early post-bypass periods are vulnerable times for provision of adequate cerebral oxygenation. Near-infrared spectroscopy is a promising tool for monitoring O2 supply/demand relationships especially during circulatory arrest. How to cite this article Mange M, Sarkar M. Cerebral Oxygenation during Pediatric Cardiac Surgery: Identification of Vulnerable Periods using Near-infrared Spectroscopy. Res Inno Anaesth 2016;1(1):15-18.

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87 Sildenafil Influence on Cerebral Oxygenation Measured by Near- Infrared Spectroscopy in Infants After Cardiac Surgery

Pediatric Research ◽

10.1203/00006450-200409000-00110 ◽

2004 ◽

Vol 56 (3) ◽

pp. 478-478 ◽

Cited By ~ 1

Author(s):

T P K Fleck ◽

N Nagdyman ◽

I Schulze-Neick ◽

B Bitterling ◽

P Ewert ◽

...

Keyword(s):

Cardiac Surgery ◽

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Cerebral Oxygenation

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Is near infrared spectroscopy valid for the detection of procedural pain in postoperative cardiac surgery intensive care unit adults?

Journal of Near Infrared Spectroscopy ◽

10.1177/0967033517730369 ◽

2017 ◽

Vol 25 (6) ◽

pp. 391-399 ◽

Cited By ~ 1

Author(s):

Céline Gélinas ◽

Madalina Boitor ◽

Manon Ranger ◽

Celeste C Johnston ◽

Michel de Marchie ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Cardiac Surgery ◽

Intensive Care ◽

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Cerebral Oxygenation ◽

Tube Removal ◽

Self Reports

This study aimed to examine the validity of the regional cerebral oxygenation using the near infrared spectroscopy technique for pain assessment in postoperative cardiac surgery adults in the intensive care unit. The near infrared spectroscopy for the assessment of pain has been studied in pediatric population, but its use in adult population especially in the critically ill is new. A total of 125 cardiac surgery intensive care unit patients from a Canadian university-affiliated hospital participated in this prospective repeated-measures study. Six assessments were completed at rest before, during, and 15 min after two procedures: (1) non-nociceptive (blood pressure measurement using cuff inflation) and (2) nociceptive (mediastinal tube removal). Regional cerebral oxygenation (%) was measured using the INVOS 5100 device (Somanetics, Troy, MI, USA). The Critical-Care Pain Observation Tool was employed to assess behavioral responses to pain. Self-reports of pain intensity and unpleasantness using 0–10 scales were also obtained. Participants were mostly males (89%) and averaged 65 of age. Regional cerebral oxygenation showed significant mild bilateral decreases (<1%; p<0.01) while higher mean Critical-Care Pain Observation Tool scores, pain intensity, and unpleasantness self-reports were obtained during mediastinal tube removal ( p < 0.001). Only the Critical-Care Pain Observation Tool score was mildly correlated to the right side regional cerebral oxygenation ( r −0.23; p < 0.01). Changes in regional cerebral oxygenation were mild and in the opposite direction. Unfortunately, the findings do not support the clinical use of the INVOS 5100 (Somanetics, Troy, MI, USA) and its regional cerebral oxygenation hemodynamic parameter for the assessment of pain in the cardiac surgery critically ill patients.

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