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Monitoring of selective antegrade cerebral perfusion using near infrared spectroscopy in neonatal aortic arch surgery

  • A. Hofer (a1), B. Haizinger (a1), G. Geiselseder (a1), R. Mair (a2), P. Rehak (a3) and H. Gombotz (a1)...

Abstract

Summary

Background and objective: To prevent neurological complications, low-flow antegrade cerebral perfusion (ACP) is used during repair of complex congenital heart defects. To overcome technical problems, continuous monitoring of cerebral blood flow and oxygenation is mandatory. The aim of the study was to evaluate the effect of different ACP flow rates on cerebral oxygen saturation obtained by near infrared spectroscopy.

Methods: Ten consecutive neonates undergoing Norwood stage I were included. In addition to near infrared spectroscopy (Invos 5100; Somanetics Corp., USA) on both hemispheres, mean arterial pressure and transcranial Doppler flow velocity were measured continuously and arterial and jugular venous oxygen saturation intermittently. Cerebral oxygen extraction ratio was calculated. Measurement points were obtained after starting bypass, during ACP with flow rates of 30, 20 and 10 mL kg−1 min−1 and immediately after ACP. ANOVA and Tukey–Kramer multiple comparison test were used for statistics.

Results: The near infrared spectroscopy signal could be obtained in all children at all measurement points, whereas transcranial Doppler failed in 1 neonate at a flow rate of 30 mL kg−1 min−1, in 3 neonates at 20 mL kg−1 min−1 and in 4 neonates at 10 mL kg−1 min−1. With the reduction of flow there was a significant decrease of cerebral oxygen saturation on both hemispheres (right: 78 ± 8 to 72 ± 9 and 66 ± 8, P < 0.001; left: 71 ± 7 to 65 ± 7 and 60 ± 7, P < 0.001), of jugular venous oxygen saturation (94 ± 6 to 89 ± 13 and 83 ± 15, P < 0.001) and a significant increase in oxygen extraction ratio (9.1 ± 8 to 14.8 ± 14 and 21 ± 16, P < 0.001) respectively, for 30, 20, 10 mL kg−1 min−1.

Conclusion: Near infrared spectroscopy reliably detects flow alterations during ACP with profound hypothermia.

Copyright

Corresponding author

Correspondence to: Anna Hofer, Department of Anaesthesiology and Intensive Care, General Hospital Linz, Krankenhausstrasse 9, A-4020 Linz, Austria. E-mail: anna.hofer@akh.linz.at; Tel: +43 732 7806 73 565; Fax: +43 732 7806 2154

References

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References

Pigula FA, Nemoto EM, Griffith BP, Siewers RD. Regional low-flow perfusion provides cerebral circulatory support during neonatal aortic arch reconstruction. J Thorac Cardiovasc Surg 2000: 119: 331339.
du Plessis AJ, Jonas RA, Wypij D, et al. Perioperative effects of alpha-stat versus pH-stat strategies for deep hypothermic cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg 1997: 114: 9911000.
Civetta JM. Critical Care.Lippincott, Williams and Wilkins, Baltimore, USA, 1996.
Greeley WJ, Bracey VA, Ungerleider RM, et al. Recovery of cerebral metabolism and mitochondrial oxidation state is delayed after hypothermic circulatory arrest. Circulation 1991; 84 (Suppl): III400III406.
Mezrow CK, Gandsas A, Sadeghi AM, et al. Metabolic correlates of neurologic and behavioral injury after prolonged hypothermic circulatory arrest. J Thorac Cardiovasc Surg 1995; 109: 959975.
Newburger JW, Jonas RA, Wernovsky G, et al. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery. New Engl J Med 1993; 329: 10571064.
Bellinger DC, Wypij D, Kuban KC, et al. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation 1999; 100: 526532.
Clancy RR, McGaurn SA, Wernovsky G, et al. Risk of seizures in survivors of newborn heart surgery using deep hypothermic circulatory arrest. Pediatrics 2003; 111: 592601.
Clancy RR, McGaurn SA, Goin JE, et al. Allopurinol neurocardiac protection trial in infants undergoing heart surgery using deep hypothermic circulatory arrest. Pediatrics 2001; 108: 6170.
Hagl C, Ergin MA, Galla JD, et al. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg 2001; 121: 11071121.
Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M. Improved results of atherosclerotic arch aneurysm operations with a refined technique. J Thorac Cardiovasc Surg 2001; 121: 491499.
Jonas RA. Optimal pH strategy for hypothermic circulatory arrest. J Thorac Cardiovasc Surg 2001; 121: 204205.
Van Haaren NJ, Bennink GB, de Vries JW. Pitfalls in neonatal cardiac surgery using antegrade cerebral perfusion. J Thorac Cardiovasc Surg 2001; 121: 184186.
Austin III EH, Edmonds JrHL, Auden SM, et al. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg 1997; 114: 707717.
Gombotz H. Neuromonitoring during hypothermic cardiopulmonary bypass. J Neurosurg Anesthesiol 1995; 7: 289296.
Ohsumi H, Kitaguchi K, Nakajima T, Ohnishi Y, Kuro M. Internal jugular bulb blood velocity as a continuous indicator of cerebral blood flow during open heart surgery. Anesthesiology 1994; 81: 325332.
Kontos HA. Validity of cerebral arterial blood flow calculations from velocity measurements. Stroke 1989; 20: 13.
Bishop CC, Powell S, Rutt D, Browse NL. Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke 1986; 17: 913915.
Burrows FA, Bissonnette B. Cerebral blood flow velocity patterns during cardiac surgery utilizing profound hypothermia with low-flow cardiopulmonary bypass or circulatory arrest in neonates and infants. Can J Anaesth 1993; 40: 298307.
Astudillo R, van der LJ, Ekroth R, et al. Absent diastolic cerebral blood flow velocity after circulatory arrest but not after low flow in infants. Ann Thorac Surg 1993; 56: 515519.
Zimmerman AA, Burrows FA, Jonas RA, Hickey PR. The limits of detectable cerebral perfusion by transcranial Doppler sonography in neonates undergoing deep hypothermic low-flow cardiopulmonary bypass. J Thorac Cardiovasc Surg 1997; 114: 594600.
Kuwabara M, Nakajima N, Yamamoto F, et al. Continuous monitoring of blood oxygen saturation of internal jugular vein as a useful indicator for selective cerebral perfusion during aortic arch replacement. J Thorac Cardiovasc Surg 1992; 103: 355362.
Kern FH, Jonas RA, Mayer JrJE, Hanley FL, Castaneda AR, Hickey PR. Temperature monitoring during CPB in infants: does it predict efficient brain cooling? Ann Thorac Surg 1992; 54: 749754.
Kern FH, Schell RM, Greeley WJ. Cerebral monitoring during cardiopulmonary bypass in children. J Neurosurg Anesthesiol 1993; 5: 213217.
Sakamoto T, Jonas RA, Stock U, et al. Utility and limitations of near-infrared spectroscopy during cardiopulmonary bypass in a piglet model. Pediatr Res 2001; 49: 770776.
Kurth CD, Steven JM, Nicolson SC. Cerebral oxygenation during pediatric cardiac surgery using deep hypothermic circulatory arrest. Anesthesiology 1995; 82: 7482.
Andropoulos DB, Diaz LK, Fraser JrCD, McKenzie ED, Stayer SA. Is bilateral monitoring of cerebral oxygen saturation necessary during neonatal aortic arch reconstruction? Anesth Analg 2004; 98: 12671272.
Ausman JI, McCormick PW, Stewart M, et al. Cerebral oxygen metabolism during hypothermic circulatory arrest in humans. J Neurosurg 1993; 79: 810815.
Kunihara T, Sasaki S, Shiiya N, Murashita T, Matsui Y, Yasuda K. Near infrared spectrophotometry reflects cerebral metabolism during hypothermic circulatory arrest in adults. ASAIO J 2001; 47: 417421.
Miyamoto K, Kawashima Y, Matsuda H, Okuda A, Maeda S, Hirose H. Optimal perfusion flow rate for the brain during deep hypothermic cardiopulmonary bypass at 20 degrees C. An experimental study. J Thorac Cardiovasc Surg 1986; 92: 10651070.
Pigula FA, Gandhi SK, Siewers RD, Davis PJ, Webber SA, Nemoto EM. Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery. Ann Thorac Surg 2001; 72: 401406.
Watanabe T, Oshikiri N, Inui K, et al. Optimal blood flow for cooled brain at 20 degrees C. Ann Thorac Surg 1999; 68: 864869.
Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology 2000; 93: 947953.

Keywords

Monitoring of selective antegrade cerebral perfusion using near infrared spectroscopy in neonatal aortic arch surgery

  • A. Hofer (a1), B. Haizinger (a1), G. Geiselseder (a1), R. Mair (a2), P. Rehak (a3) and H. Gombotz (a1)...

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