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Eur J Cardiothorac Surg 1998;13:370-377
© 1998 Elsevier Science NL

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

Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton, SO16 6YD, UK

Received 1 September 1997; received in revised form 15 December 1997; accepted 6 January 1998.

Corresponding author. Present address. Division of Cardiology, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue at De Soto Street, Pittsburgh, PA 15213, USA. Tel.: +1 412 6925541; fax: +1 412 6925138; e-mail: Steven_Webber@poplar.chp.edu

Objective: Neurologic sequelae remain a well recognised complication of paediatric cardiac surgery. Monitoring of cerebral oxygenation may be a useful technique for identifying vulnerable periods for the development of neurologic injury. We sought to measure regional cerebral oxygenation in children undergoing cardiac surgery using near infrared spectroscopy to ascertain such vulnerable periods. Methods: Observational study of 18 children (median age 1.3 years) undergoing cardiac surgery (17 with cardiopulmonary bypass, 8 with circulatory arrest). Regional cerebral oxygenation was monitored using the INVOS 3100 cerebral oximeter and related to haemodynamic parameters at each stage of the procedure. Results: Prior to the onset of bypass, 10 patients had a decrease in regional cerebral oxygenation of 15% points, reaching an absolute haemoglobin 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 by a mean 18% points to a mean maximum of 75%. During circulatory arrest regional cerebral oxygenation decreased with rate of decay influenced by temperature at onset of arrest (0.25%/min at <20°C; 2%/min at >20°C). Reperfusion caused an immediate increase in regional cerebral oxygenation followed by a decrease during rewarming. Discontinuation of bypass caused a precipitous decrease in regional cerebral oxygenation in 5 patients, reaching less than 50% in 3 patients. 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.

Key Words: Cerebral oximetry • Children • Cardiopulmonary bypass • Deep hypothermic circulatory arrest • Near infrared spectroscopy

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