Perioperative near-infrared spectroscopy cerebral oxygen saturation in symptomatic pediatric hydrocephalus patients at risk for intracranial hypertension

2020 ◽  
Vol 25 (3) ◽  
pp. 235-241
Author(s):  
Shih-Shan Lang ◽  
Omaditya Khanna ◽  
Natalie J. Atkin ◽  
Judy E. Palma ◽  
Ian Yuan ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Near Infrared ◽  
Pediatric Patients ◽  
Cerebral Oxygenation ◽  
Clinical Symptoms ◽  
Cerebral Oxygen ◽  
Pediatric Hydrocephalus ◽  
Before And After ◽  
Csf Diversion ◽  
The Mean

OBJECTIVEThe lack of a continuous, noninvasive modality for monitoring intracranial pressure (ICP) is a major obstacle in the care of pediatric patients with hydrocephalus who are at risk for intracranial hypertension. Intracranial hypertension can lead to cerebral ischemia and brain tissue hypoxia. In this study, the authors evaluated the use of near-infrared spectroscopy (NIRS) to measure regional cerebral oxygen saturation (rSO2) in symptomatic pediatric patients with hydrocephalus concerning for elevated ICP.METHODSThe authors evaluated the NIRS rSO2 trends in pediatric patients presenting with acute hydrocephalus and clinical symptoms of intracranial hypertension. NIRS rSO2 values were recorded hourly before and after neurosurgical intervention. To test for significance between preoperative and postoperative values, the authors constructed a linear regression model with the rSO2 values as the outcome and pre- and postsurgery cohorts as the independent variable, adjusted for age and sex, and used the generalized estimating equation method to account for within-subject correlation.RESULTSTwenty-two pediatric patients underwent NIRS rSO2 monitoring before and after CSF diversion surgery. The mean durations of NIRS rSO2 recording pre- and postoperatively were 13.95 and 26.82 hours, respectively. The mean pre- and postoperative rSO2 values were 73.84% and 80.65%, respectively, and the adjusted mean difference estimated from the regression model was 5.98% (adjusted p < 0.0001), suggestive of improved cerebral oxygenation after definitive neurosurgical CSF diversion treatment. Postoperatively, all patients returned to baseline neurological status with no clinical symptoms of elevated ICP.CONCLUSIONSCerebral oxygenation trends measured by NIRS in symptomatic pediatric hydrocephalus patients with intracranial hypertension generally improve after CSF diversion surgery.

Cerebral oxygen saturation changes during modified ultrafiltration

Perfusion ◽  
2006 ◽  
Vol 21 (6) ◽  
pp. 325-328 ◽  
Author(s):  
William M Medlin ◽  
Joseph J Sistino
Keyword(s):  
Oxygen Saturation ◽  
Oxygen Delivery ◽  
Pediatric Patients ◽  
Cerebral Oxygenation ◽  
Myocardial Edema ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Hemodynamic Stability ◽  
Transfusion Requirements ◽  
Cerebral Tissue Oxygenation

Background: A number of adverse effects are associated with the use of cardiopulmonary bypass (CPB) in pediatric patients undergoing cardiac surgery. Pulmonary compliance and gas exchange are decreased, and myocardial edema may result in diastolic dysfunction. Modified ultrafiltration (MUF) after CPB in children decreases body water, removes inflammatory mediators, improves hemodynamics, and decreases transfusion requirements. Purpose: To determine the factors that influence cerebral tissue oxygenation during MUF. Pediatric patients received the usual treatment, with MUF times from 10 to 19 min, as determined by circuit volume and patient hemodynamic stability. Results: Preliminary results in five patients with arterial saturation >95% during MUF demonstrates four predictors of cerebral oxygenation, using stepwise multiple linear regression with cerebral oxygen saturation as the dependant variable. In order of significance, they are pCO2, ultrafiltration flow rate, mean arterial pressure, and hematocrit. Conclusions: The results of this study will be used to determine the optimal performance of MUF. Maximizing cerebral oxygen delivery during this early post-bypass period is extremely important, and identifying the factors responsible for increased cerebral oxygen delivery during MUF allows the clinician to make the appropriate changes necessary to achieve this.

SURGICAL TREATMENT OF RATHKE CLEFT CYSTS IN CHILDREN

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. 1132-1138 ◽  
Author(s):  
Gabriel Zada ◽  
Benjamin Ditty ◽  
Sean A. McNatt ◽  
J. Gordon McComb ◽  
Mark D. Krieger
Keyword(s):  
Surgical Treatment ◽  
Los Angeles ◽  
Transsphenoidal Surgery ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Incidental Finding ◽  
Effective Means ◽  
Sellar Lesions ◽  
Endocrine Insufficiency ◽  
The Mean

Abstract OBJECTIVE Rathke cleft cysts (RCCs) are cystic epithelial lesions in the sellar and suprasellar regions that are often discovered incidentally. They require surgical fenestration and drainage in a small proportion of patients who develop symptoms or demonstrate progressive enlargement. Our aim was to review our experience with pediatric patients treated surgically for RCCs. METHODS A retrospective review was conducted of all patients treated surgically for RCCs at Childrens Hospital Los Angeles between 1999 and 2007 after approval by the institutional review board. Clinical notes, operative reports, radiological studies, and pathology reports were reviewed. The median follow-up period was 34 months. RESULTS Ten patients undergoing surgical treatment of an RCC were identified, making up 20% of the 51 patients with RCCs followed clinically over the same time period. The mean age was 13 years (age range, 2–17 years). There were 6 females and 4 males. Patients requiring surgery presented with the following clinical symptoms: headache (8 patients, 80%), endocrine insufficiency (6 patients, 60%), meningitis followed by visual loss (1 patient, 10%), and incidental finding (1 patient, 10%). The mean cyst diameter was 13.6 mm (range, 8–18 mm). Four patients had strictly sellar lesions, 4 patients had suprasellar extension of an RCC, and 2 patients had primarily suprasellar RCCs. Nine of 10 patients underwent transsphenoidal surgery, and 1 patient underwent a pterional craniotomy. Complete cyst drainage on radiography was noted in 9 of 10 patients (90%), all of whom underwent transsphenoidal surgery. One patient experienced a symptomatic recurrence 6 years after complete surgical drainage. Headaches improved in 7 of 8 patients after surgery. Two patients had complete resolution of a hormonal axis deficit, whereas 3 patients developed new anterior pituitary axis deficits. Two patients developed persistent diabetes insipidus after surgery. CONCLUSION RCCs are an infrequent cause of symptoms in pediatric patients. The transsphenoidal approach offers an effective means of achieving complete cyst drainage for lesions requiring surgery. Fenestration and aspiration of the cyst are usually sufficient to achieve total resolution of symptoms and signs caused by RCCs. Clinical symptoms such as headaches improved in the majority of patients, whereas hormonal disturbances typically persisted. Patient selection remains of paramount importance when considering surgery for pediatric patients with RCCs.

The effect of pulsatile versus non-pulsatile flow during cardiopulmonary bypass on cerebral oxygenation: A randomized trial

2021 ◽  
pp. 021849232110459
Author(s):  
Samira Moosaeifar ◽  
Mostafa Mousavizadeh ◽  
Tahereh Najafi Ghezeljeh ◽  
Afshin Hosseinian ◽  
Touraj Babaee ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Cardiopulmonary Bypass ◽  
Near Infrared Spectroscopy ◽  
Pulsatile Flow ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation ◽  
Time Points ◽  
Pulsatile Perfusion

Background The present study aims to compare regional oxygen supply determined by Near-Infrared Spectroscopy in the course of pulsatile perfusion with non-pulsatile perfusion during cardiopulmonary bypass in patients undergoing valvular heart surgery. Methods In this prospective randomized single-blinded trial, we enrolled adult subjects aged 18–65 years scheduled for elective valvular heart repair/replacement surgery with non-stenotic carotid arteries, employing a consecutive sampling method. Eligible patients were then randomly assigned in a 1:1 ratio to pulsatile or non-pulsatile perfusion during aortic cross-clamp. The primary outcome was regional cerebral oxygenation monitored by Near-Infrared Spectroscopy in each group. Results Seventy patients were randomly assigned, and each group comprised 35 patients. Mean age was 46.8 and 46.5 years in pulsatile and non-pulsatile groups, respectively. There were no significant between-group differences in regional cerebral oxygen saturation at different time points of cardiopulmonary bypass ( p-value for analysis of variance repeated measures: 0.923 and 0.223 for left and right hemispheres, respectively). Moreover, no significant differences in regional cerebral oxygen saturation levels from baseline between pulsatile and non-pulsatile groups at all desired time points for the left ( p = 0.51) and right ( p = 0.22) hemispheres of the brain were detected. Conclusion Pulsatile perfusion during cardiopulmonary bypass does not offer superior regional cerebral oxygenation measured by Near-Infrared Spectroscopy than non-pulsatile perfusion during cardiopulmonary bypass. Nonetheless, the efficacy of pulsatile flow in the subgroup of patients in whom cerebral blood flow is impaired due to carotid artery stenosis needs to be explored and evaluated by this method in future studies.

scholarly journals PlanHab: hypoxia exaggerates the bed-rest-induced reduction in peak oxygen uptake during upright cycle ergometry

2016 ◽  
Vol 311 (2) ◽  
pp. H453-H464 ◽  
Author(s):  
Michail E. Keramidas ◽  
Roger Kölegård ◽  
Igor B. Mekjavic ◽  
Ola Eiken
Keyword(s):  
Oxygen Uptake ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Vastus Lateralis ◽  
Bed Rest ◽  
Peak Oxygen Uptake ◽  
Cycle Ergometry ◽  
Vastus Lateralis Muscle ◽  
Before And After ◽  
Exercise Induced

The study examined the effects of hypoxia and horizontal bed rest, separately and in combination, on peak oxygen uptake (V̇o2 peak) during upright cycle ergometry. Ten male lowlanders underwent three 21-day confinement periods in a counterbalanced order: 1) normoxic bed rest [NBR; partial pressure of inspired O2(PiO2) = 133.1 ± 0.3 mmHg]; 2) hypoxic bed rest (HBR; PiO2= 90.0 ± 0.4 mmHg), and 3) hypoxic ambulation (HAMB; PiO2= 90.0 ± 0.4 mmHg). Before and after each confinement, subjects performed two incremental-load trials to exhaustion, while inspiring either room air (AIR), or a hypoxic gas (HYPO; PiO2= 90.0 ± 0.4 mmHg). Changes in regional oxygenation of the vastus lateralis muscle and the frontal cerebral cortex were monitored with near-infrared spectroscopy. Cardiac output (CO) was recorded using a bioimpedance method. The AIR V̇o2 peakwas decreased by both HBR (∼13.5%; P ≤ 0.001) and NBR (∼8.6%; P ≤ 0.001), with greater drop after HBR ( P = 0.01). The HYPO V̇o2 peakwas also reduced by HBR (−9.7%; P ≤ 0.001) and NBR (−6.1%; P ≤ 0.001). Peak CO was lower after both bed-rest interventions, and especially after HBR (HBR: ∼13%, NBR: ∼7%; P ≤ 0.05). Exercise-induced alterations in muscle and cerebral oxygenation were blunted in a similar manner after both bed-rest confinements. No changes were observed in HAMB. Hence, the bed-rest-induced decrease in V̇o2 peakwas exaggerated by hypoxia, most likely due to a reduction in convective O2transport, as indicated by the lower peak values of CO.

Double-Chambered Right Ventricle in Adulthood

2005 ◽  
Vol 13 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Mitsugi Nagashima ◽  
Tetsuo Tomino ◽  
Harumitsu Satoh ◽  
Tatsuhiro Nakata ◽  
Takashi Ohtani ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Right Ventricular Outflow Tract ◽  
Heart Association ◽  
Ventricular Outflow Tract ◽  
Functional Class ◽  
Surgical Correction ◽  
Growth Delay ◽  
The Mean

Patients with double-chambered right ventricle presenting with symptoms in adulthood are rare. From 1990 to 2004, 4 adults and 9 children with double-chambered right ventricle underwent surgical correction. The surgical results and clinical data of the adults were compared with those of the pediatric patients. All adult patients had dyspnea on exertion, 3 children showed growth delay but the others were asymptomatic. The mean age at operation was 44.5 ± 6.3 years in adults and 5.2 ± 1.9 years in children. The mean pressure gradient between the anatomically lower right ventricle and the pulmonary artery was significantly higher in adults than in children (91.8 ± 14.1 vs. 42.2 ± 5.9 mm Hg). The pulmonary-to-systemic flow ratio in adults was significantly lower than in pediatric patients (1.2 ± 0.2 vs. 1.8 ± 0.3). All adults and 8 of the 9 children survived. There were no late deaths or re-operations, and all survivors were in New York Heart Association functional class I. Surgical correction of double-chambered right ventricle in adults gave satisfactory midterm results although right ventricular outflow tract obstruction and clinical symptoms were severe in these patients.

scholarly journals Pengaruh peningkatan dosis kalsium terhadap tekanan darah pada ibu hamil di RSUP Dr Mdjamil Padang

2018 ◽  
Vol 2 (1) ◽  
pp. 26-36
Author(s):  
Ariadi Ariadi ◽  
Syaiful Azmi ◽  
Hafni Bachtiar
Keyword(s):  
Blood Pressure ◽  
Calcium Intake ◽  
Clinical Symptoms ◽  
Pearson Correlation ◽  
Test Group ◽  
Maternal Blood ◽  
Wilcoxon Test ◽  
Before And After ◽  
The Mean ◽  
Maternal Blood Pressure

Until recently, the exact etiology and pathophysiology of preeclampsia have not been discovered yet, but based on the clinical symptoms and the defect that appeared, researchers submitted some ways as assumption or as early detection of preeclampsia and eclampsia. Some researchers have suggested the examination of calcium / creatinine excretion ratio in urine from preeclampsia patients as the result of kidney's function changes. This study has been performed with a pre and post test group design experimental method at Obstetric and Gynecology Polyclinic in RS. Dr. M. Djamil Padang and several midwife private practices in Padang since July 2013 until the samples reached the quantity up to 40 samples. Analysis has been done to describe the relationship between calcium intake and blood pressure. Furthermore, we analyzed the differences of systolic - diastolic and MAP before and after calcium intake. Data has been shown on the table and analyzed by Pearson correlation, Wilcoxon test and Paired T test. if p <0.05, it shows a significant result. The mean of systolic after calcium intake was the same for both of the groups (121.5 + 8.02: 121.5 + 6.71). Mean of diastolic after calcium intake in controls group was lower than trials group (75.9 + 4.32: 75.9 + 4.32). Mean of MAP after calcium intake for controls group was lower that trials group (91,088 + 4.47: 91,956 + 6.08). There is an influence of calcium intake on decreasing maternal blood pressure. The mean of systolic after calcium intake was the same for both of the groups (121.5 + 8.02: 121.5 + 6.71). Mean of diastolic after calcium intake in controls group was lower than trials group (75.9 + 4.32: 75.9 + 4.32). Mean of MAP after calcium intake for controls group was lower that trials group (91,088 + 4.47: 91,956 + 6.08). There is an influence of calcium intake on decreasing maternal blood pressure. The mean of systolic after calcium intake was the same for both of the groups (121.5 + 8.02: 121.5 + 6.71). Mean of diastolic after calcium intake in controls group was lower than trials group (75.9 + 4.32: 75.9 + 4.32). Mean of MAP after calcium intake for controls group was lower that trials group (91,088 + 4.47: 91,956 + 6.08). There is an influence of calcium intake on decreasing maternal blood pressure.Keywords: Systolic, Diastolic, Mean Arterial Pressure (MAP)

scholarly journals A Comparison of the Hamamatsu NIRO 500 and the INVOS 3100 Near-Infrared Spectrophotometers

1998 ◽  
Vol 26 (5) ◽  
pp. 548-557 ◽  
Author(s):  
C. D. Gomersall ◽  
P. L. Leung ◽  
T. Gin ◽  
G. M. Joynt ◽  
R. J. Young ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Haemoglobin Concentration ◽  
Carbon Dioxide Tension ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Infrared Spectrophotometer ◽  
Total Haemoglobin ◽  
End Tidal

Near-infrared spectroscopy is a technique used for non-invasive measurement of cerebral oxygenation and a number of commercial devices are currently available for use. We compared measurements of cerebral oxygenation made with two near-infrared spectrophotometers—the Somanetics Invos 3100 cerebral oximeter and the Hamamatsu NIRO-500 near-infrared spectrophotometer. Hypoxia was induced in six healthy male volunteers with and without occlusion of scalp blood flow. Oxygen saturation, end-tidal carbon dioxide tension, regional cerebral oxygen saturation, change in regional cerebral oxyhaemoglobin concentration and change in regional cerebral total haemoglobin concentration were measured. The INVOS 3100 displays cerebral oxygen saturation directly. The NIRO-500 displays change in total haemoglobin concentration and oxyhaemoglobin concentration, and the cerebral oxygen saturation was calculated offline. Statistical analysis disproved the assumption that the INVOS 3100 and the NIRO-500 were measuring the same changes in cerebral oxygenation. Neither machine can be confirmed for reliability against a gold standard and operational difficulties mean that neither can be recommended for routine clinical use.

scholarly journals Changes in cerebral oxygen saturation and cerebral blood flow velocity under mild +Gz hypergravity

2019 ◽  
Vol 127 (1) ◽  
pp. 190-197 ◽  
Author(s):  
Toru Konishi ◽  
Takuya Kurazumi ◽  
Tomokazu Kato ◽  
Chiharu Takko ◽  
Yojiro Ogawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Infrared Spectroscopy ◽  
Oxygen Saturation ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Regional Cerebral Oxygen Saturation

We previously reported that cerebral blood flow (CBF) was reduced by even mild +Gz hypergravity. Regional cerebral oxygen saturation as measured by near-infrared spectroscopy (C-rSO2) has been widely used to detect cerebral ischemia in clinical practice. For example, decreases in C-rSO2reflect reduced CBF or arterial oxygen saturation. Thus it was hypothesized that C-rSO2would decrease in association with reduced CBF during mild hypergravity. To test this hypothesis, we measured CBF velocity by transcranial Doppler ultrasonography and C-rSO2during mild +Gz hypergravity while participants were in a sitting position. Among 17 male participants, 15 completed 21 min of exposure to +1.5 Gz generated by short-arm centrifuge. C-rSO2and mean CBF velocity in the middle cerebral artery (MCBFVMCA) during centrifugation were averaged every 5 min and compared with pre-hypergravity (+1.0 Gz). C-rSO2did not change significantly throughout centrifugation, although MCBFVMCAgradually decreased from the beginning (−1.2% at 0–5 min), and significantly decreased at 5–10 min (−4.8%), 10–15 min (−6.7%), and 15–20 min (−7.4%). Contrary to our hypothesis, decreases in C-rSO2were not detected, despite reductions in CBF velocity during hypergravity. Since some assumptions, such as unaltered arteriovenous volume ratio, hemoglobin concentration, extracranial blood flow, and brain activity, need to be satisfied to monitor cerebral ischemia by C-rSO2, the present results suggest that these necessary assumptions for near-infrared spectroscopy are not always applicable, and that cerebral oxygenation may not precisely reflect decreases in CBF under mild +Gz hypergravity.NEW & NOTEWORTHY To our knowledge, this is the first study to evaluate simultaneously cerebral oxygenation monitored by near-infrared spectroscopy and cerebral blood flow (CBF) monitored by transcranial Doppler under +1.5 Gz hypergravity. Contrary to our hypothesis, there was no significant correlation between CBF velocity and regional cerebral oxygen saturation (C-rSO2). However, an incomplete case nearly involving syncope suggests the possibility that C-rSO2can detect a remarkable decrease in CBF with development of presyncope during +Gz hypergravity.

Laser scanning tomography measurement of the extent of papilledema in the follow-up examination of patients with idiopathic intracranial hypertension

2007 ◽  
Vol 107 (3) ◽  
pp. 543-547 ◽  
Author(s):  
Josef G. Heckmann ◽  
Florian Faschingbauer ◽  
Christoph Lang ◽  
Udo Reulbach ◽  
Matthias Dütsch ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Optic Disc ◽  
Idiopathic Intracranial Hypertension ◽  
Laser Scanning ◽  
Clinical Symptoms ◽  
Characteristic Curve ◽  
Clinical Parameters ◽  
Opening Pressure ◽  
The Mean

Object The authors evaluated the characteristics of patients with idiopathic intracranial hypertension (IIH), and compared laser scanning tomography (LST) measurements of papilledema with the clinical parameters and cerebrospinal fluid (CSF) opening pressures obtained. Methods Twenty-four patients were included in this study; these individuals included 21 women and three men with a mean age of 35.5 ± 9.7 years and a mean body mass index (BMI) of 35.4 ± 8.3 kg/m2. The authors conducted a prospective follow-up study over a period of 12 months through a series of four consultations with each patient. These patients had a mean time to treatment of 6.2 ± 7.9 months and, at the time of diagnosis, suffered a mean of 2.8 ± 1.3 symptoms each. Laser scanning tomography of the optic disc revealed a mean global rim volume of 1.693 ± 1.662 mm3 and a mean height of 0.604 ± 0.306 mm. The mean CSF opening pressure was 31.3 ± 6.3 cm H20. Results During the follow-up period, all patients improved significantly with regard to clinical parameters (p < 0.001), BMI reduction (p < 0.001), and reduction of visual field deficits (p = 0.007); visual acuity remained unchanged. In all patients at each successive consultation, the CSF opening pressure was lower than it had been at the previous consultation (p = 0.001). Laser scanning tomography measurements demonstrated a statistically significant reduction in both optic disc parameters over the follow-up period (global rim volume, p = 0.044; mean height, p = 0.019). The CSF opening pressure and the LST measurements correlated significantly with the number of symptoms (CSF opening pressure, p < 0.001; global rim volume, p = 0.001; mean height, p < 0.001). The mean area under the receiver operating characteristic curve in detecting the presence of clinical symptoms was 0.87 for CSF opening pressure, 0.7 for rim volume, and 0.81 for mean optic disc height. Conclusions Laser scanning tomography measurements are useful for evaluating the degree of papilledema in patients with IIH and correspond well with clinical data and measurements of CSF opening pressure. If a diagnosis of IIH is established, LST measurements may replace repeated CSF opening pressure measurements in follow-up monitoring.

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