scholarly journals Effect of hemoglobin content on cerebral oxygen saturation during surgery for scoliosis in pediatric patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lin Liu ◽  
Zhipeng Qiang ◽  
Jianmin Zhang ◽  
Yi Ren ◽  
Xin Zhao ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Pediatric Patients ◽  
Fluid Replacement ◽  
Cerebral Oxygen Saturation ◽  
Carbon Dioxide Partial Pressure ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Hemoglobin Content ◽  
Arterial Blood ◽  
Scoliosis Correction

Abstract Background Although regional cerebral oxygen saturation (rScO2) monitoring has been widely used in clinical practice, the relationship between hemoglobin (dHB) content and rScO2 is incompletely understood. The aim of this study was to analyze the effect of hemoglobin content on rScO2 in pediatric patients undergoing general anesthesia for correction of scoliosis. Methods Ninety-two pediatric patients aged 3 to 14 years undergoing scoliosis correction surgery were enrolled. Continuous monitoring of bilateral regional cerebral oxygen saturation by near-infrared spectroscopy (NIRS, CASMED, USA) was performed after entering the operation room. rScO2 was recorded when the patients entered the operating room (T0, baseline), after anesthesia induced intubation (T1), and after radial artery puncture (T2). The lowest value of rScO2 during surgery was also recorded. The arterial blood pressure (ABP), heart rate (HR), pulse oxygen saturation (SpO2), end tidal carbon dioxide partial pressure (PetCO2) were continuously recorded. Patients were classified as low rScO2 or high rScO2 group according to whether the lowest intraoperative rScO2 was 15% lower than the baseline value. An analysis and comparison of differences in hemoglobin content in these two groups was carried out. Results The preoperative hemoglobin-postoperative hemoglobin of patients in the high rScO2 group was significantly lower than that in the low rScO2 group (t = − 7.86, p < 0.01), the amount of bleeding during the operation was also less than that in the low rScO2 group (t = − 6.05, p < 0.01), and the systolic pressure of patients was higher than that in the low rScO2 group (t = 4.27, p < 0.01). Conclusions The decrease in hemoglobin level which occurs during surgery leads to a decrease in cerebral oxygen saturation. In order to ensure patient safety during surgery, it is necessary to carry out volume management and appropriate transfusion and fluid replacement in a timely manner. Trial registration Chinese Clinical Trial Registry, ChiCTR1800016359. Registered 28 May 2018.

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

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Peiyi Li ◽  
Jun Zeng ◽  
Wei Wei ◽  
Jing Lin
Keyword(s):  
Oxygen Saturation ◽  
Near Infrared ◽  
Controlled Trial ◽  
Cerebral Oxygen Saturation ◽  
Patient Specific ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Observation Study ◽  
Arterial Blood ◽  
Stabilization Period

Abstract 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.

Abstract 65: Evaluating the Role of Continuously Monitoring Regional Cerebral Oxygen Saturation in Predicting the Return of Spontaneous Circulation in Cardiac Arrest Patients: Does the Use of an Electrocardiogram Alone Provide Adequate Information During Cardiopulmonary Resuscitation?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hitoshi Kano ◽  
Tomoyo Saito ◽  
Toshihisa Matsui ◽  
Akio Endo ◽  
Masaki Nagama ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Oxygen Saturation ◽  
Near Infrared ◽  
Tissue Oxygenation ◽  
Oxygenation Index ◽  
Cerebral Oxygen Saturation ◽  
Infrared Light ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Brain Tissue Oxygenation

During CPR as it is currently administered, treatments are selected from an algorithm derived by monitoring with ECG alone. One of the reasons for this is that no other devices are presently thought to be effective in helping to make treatment determinations. Monitoring of regional cerebral oxygen saturation with near infrared light is non-invasive and provides information on brain tissue oxygenation and hemodynamics. The results of our study suggest that measurements derived from continuously monitoring regional cerebral oxygen saturation during CPR can be considered an effective method of predicting the ROSC in cardiac arrest patients. Methods: In 95 patients with out-of-hospital cardiac arrest, the tissue oxygenation index (TOI) was continuously monitored (NIRO-200NX, Hamamatsu Photonics). We investigated the following parameters with respect to whether or not ROSC was achieved: TOI value at the contact of patients (initial TOI); TOI value just before ROSC (pre-ROSC TOI); and the maximum TOI during CPR (maximum TOI). Results: All the patients monitored received treatment with shocks or drugs and the initial TOI was 35.3±7.3%. For 74 patients who did not achieve ROSC, the maximum TOI was 41.0±7.4%, whereas for 21 patients who did achieve ROSC, the pre-ROSC TOI was 51.3±3.6% and the maximum TOI was 64.3±11.4%. ROSC was not achieved in the patients with maximum TOI below 45%. Conclusion: The pre-ROSC TOI was significantly higher than the maximum TOI in the patients who did not achieve ROSC which suggests the possibility of predicting ROSC by monitoring the increase in TOI. In cases where the TOI remains low, there is a possibility that ROSC should not be expected. In such cases, it may be desirable to attempt to improve the quality of CPR to increase the TOI before delivering shocks or administering drugs.

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