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Effects of different ventilation on cerebral oxygen saturation and cerebral blood flow before and after modified ultrafiltration in infants during ventricular septal defect repair

Published online by Cambridge University Press:  05 February 2021

Boqun Cui
Affiliation:
Anesthesia Center, Capital Medical University affiliated Beijing An Zhen Hospital, Beijing, China
Chuan Ou-Yang
Affiliation:
Anesthesia Center, Capital Medical University affiliated Beijing An Zhen Hospital, Beijing, China
Siyuan Xie
Affiliation:
Anesthesia Center, Capital Medical University affiliated Beijing An Zhen Hospital, Beijing, China Department of Anesthesiology, Capital Institute of Pediatrics affiliated Children’s Hospital, Beijing, China
Duomao Lin
Affiliation:
Anesthesia Center, Capital Medical University affiliated Beijing An Zhen Hospital, Beijing, China
Jun Ma*
Affiliation:
Anesthesia Center, Capital Medical University affiliated Beijing An Zhen Hospital, Beijing, China
*
Address for correspondence: Jun Ma MD, Anesthesia Center, Capital Medical University affiliated Beijing An Zhen Hospital, Beijing, China. Tel: +860 106 445 6779; Fax: +860 106 445 6779. E-mail: majuntongxun@sohu.com

Abstract

Objective:

To analyse the changes of different ventilation on regional cerebral oxygen saturation and cerebral blood flow in infants during ventricular septal defect repair.

Methods:

Ninety-two infants younger than 1 year were enrolled in the study. End-expiratory tidal pressure of carbon dioxide was maintained at 40–45 and 35–39 mmHg in relative low and high ventilation groups. Regional cerebral oxygen saturation and flow velocity of the middle cerebral artery were recorded after anaesthesia (T0), cut pericardium (T1), separation from cardiopulmonary bypass (T2), the end of modified ultrafiltration, (T3) and at the end of operation (T4).

Results:

The relative low ventilation group exhibited a significantly high regional cerebral oxygen saturation at each time point except for T2 (T0:77 ± 4, T1:76 ± 5, T3:76 ± 8, T4:76 ± 8, respectively, p < 0.001). Flow velocity of the middle cerebral artery in the relative low ventilation group was higher compared to the relative high ventilation group at each time point except for T2 (T0:53 ± 14, T1:54 ± 15, T3:53 ± 17, T4:52 ± 16, respectively, p < 0.001). Between the two groups, T2 showed the lowest middle cerebral artery flow velocity (relative low ventilation: 39 ± 15, relative high ventilation: 39 ± 11, p < 0.001).

Conclusion:

The infants’ regional cerebral oxygen saturation and middle cerebral artery flow velocity performed better in the range of 40–45 mmHg end-expiratory tidal pressure of carbon dioxide during CHD surgery. Modified ultrafiltration increased cerebral oxygen saturation. It was important to regulate ventilation in order to balance cerebral oxygen in infants.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

Boqun Cui and Chuan Ou-Yang contributed equally to this work.

References

Picciolini, O, Squarza, C, Fontana, C, et al. Neurodevelopmental outcome of extremely low birth weight infants at 24 months corrected age: a comparison between Griffiths and Bayley Scales. BMC Pediatr 2015; 15: 139.CrossRefGoogle ScholarPubMed
Furnish, C, Mueller, SW, Kiser, TH, Dufficy, L, Sullivan, B, Beyer, JT. Hydroxocobalamin versus methylene blue for vasoplegic syndrome in cardiothoracic surgery: a retrospective cohort. J Cardiothorac Vasc Anesth 2020; 34: 17631770.CrossRefGoogle ScholarPubMed
Andropoulos, DB, Stayer, SA, Diaz, LK, Ramamoorthy, C. Neurological monitoring for congenital heart surgery. Anesth Analg 2004; 99: 13651375.CrossRefGoogle ScholarPubMed
Hayashida, M, Kin, N, Tomioka, T, et al. Cerebral ischaemia during cardiac surgery in children detected by combined monitoring of BIS and near-infrared spectroscopy. Br J Anaesth 2004; 92: 662669.CrossRefGoogle ScholarPubMed
Schober, A, Feiner, JR, Bickler, PE, Rollins, MD. Effects of changes in arterial carbon dioxide and oxygen partial pressures on cerebral oximeter performance. Anesthesiology 2018; 128: 97108.CrossRefGoogle ScholarPubMed
Ricci, Z, Garisto, C, Favia, I, et al. Cerebral NIRS as a marker of superior vena cava oxygen saturation in neonates with congenital heart disease. Paediatr Anaesth 2010; 20: 10401045.CrossRefGoogle ScholarPubMed
Li, J, Zhang, G, Holtby, H, et al. Carbon dioxide–a complex gas in a complex circulation: its effects on systemic hemodynamics and oxygen transport, cerebral, and splanchnic circulation in neonates after the Norwood procedure. J Thorac Cardiovasc Surg 2008; 136: 12071214.CrossRefGoogle Scholar
Zhang, W, Xie, S, Han, D, Huang, J, Ou-Yang, C, Lu, J. Effects of relative low minute ventilation on cerebral haemodynamics in infants undergoing ventricular septal defect repair. Cardiol Young 2020: 18.Google ScholarPubMed
Medlin, WM, Sistino, JJ. Cerebral oxygen saturation changes during modified ultrafiltration. Perfusion 2006; 21: 325328.CrossRefGoogle ScholarPubMed
Vutskits, L. Cerebral blood flow in the neonate. Paediatr Anaesth 2014; 24: 2229.CrossRefGoogle ScholarPubMed
Rhondali, O, Mahr, A, Simonin-Lansiaux, S, et al. Impact of sevoflurane anesthesia on cerebral blood flow in children younger than 2 years. Paediatr Anaesth 2013; 23: 946951.CrossRefGoogle ScholarPubMed
Grüne, F, Kazmaier, S, Stolker, RJ, Visser, GH, Weyland, A. Carbon dioxide induced changes in cerebral blood flow and flow velocity: role of cerebrovascular resistance and effective cerebral perfusion pressure. J Cereb Blood Flow Metab 2015; 35: 14701477.CrossRefGoogle ScholarPubMed
Abu-Sultaneh, S, Hehir, DA, Murkowski, K, et al. Changes in cerebral oxygen saturation correlate with S100B in infants undergoing cardiac surgery with cardiopulmonary bypass. Pediatr Crit Care Med 2014; 15: 219228.CrossRefGoogle ScholarPubMed
Polito, A, Ricci, Z, Di Chiara, L, et al. Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler–a systematic review of the literature. Cardiovasc Ultrasound 2006; 4: 47.CrossRefGoogle ScholarPubMed
Kotlinska-Hasiec, E, Czajkowski, M, Rzecki, Z, et al. Disturbance in venous outflow from the cerebral circulation intensifies the release of blood-brain barrier injury biomarkers in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2014; 28: 328335.CrossRefGoogle ScholarPubMed
Fogel, MA, Li, C, Elci, OU, et al. Neurological injury and cerebral blood flow in single ventricles throughout staged surgical reconstruction. Circulation 2017; 135: 671682.CrossRefGoogle ScholarPubMed
Naik, SK, Knight, A, Elliott, M. A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 1991; 84: III422–31.Google Scholar
Rodriguez, RA, Ruel, M, Broecker, L, Cornel, G. High flow rates during modified ultrafiltration decrease cerebral blood flow velocity and venous oxygen saturation in infants. Ann Thorac Surg 2005; 80: 2228.CrossRefGoogle ScholarPubMed
Aeba, R, Katogi, T, Omoto, T, Kashima, I, Kawada, S. Modified ultrafiltration improves carbon dioxide removal after cardiopulmonary bypass in infants. Artif Organs 2000; 24: 300304.CrossRefGoogle ScholarPubMed
Kotani, Y, Honjo, O, Osaki, S, et al. Effect of modified ultrafiltration on post-operative course in neonates with complete transposition of the great arteries undergoing arterial switch operation. Circ J 2008; 72: 14761480.CrossRefGoogle ScholarPubMed
Wyatt, J, Meek, J. Commentary on cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics 2000; 106: 828.CrossRefGoogle ScholarPubMed
Lucas, SJE, Tzeng, YC, Galvin, SD, Thomas, KN, Ogoh, S, Ainslie, PN. Influence of changes in blood pressure on cerebral perfusion and oxygenation. Hypertension 2010; 55: 698705.CrossRefGoogle ScholarPubMed
Wong, FY, Leung, TS, Austin, T, et al. Impaired auto-regulation in preterm infants identified by using spatially resolved spectroscopy. Pediatrics 2008; 121: e604e611.CrossRefGoogle Scholar
Tsuji, M, Saul, JP, du Plessis, A, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatrics 2000; 106: 625632.CrossRefGoogle ScholarPubMed
Shen, J, Wang, W, Zhang, W, Jiang, L, Yang, YY. A high-efficiency MUF method benefits post-operative hemodynamic stability and oxygen delivery in neonates with transposition of great arteries. J Card Surg 2019; 34: 468473.CrossRefGoogle ScholarPubMed
Robertson, DR, Justo, RN, Burke, CJ, Pohlner, PG, Graham, PL, Colditz, PB. Perioperative predictors of developmental outcome following cardiac surgery in infancy. Cardiol Young 2004; 14: 389395.CrossRefGoogle ScholarPubMed
Dodds, C. Carbon dioxide and the cerebral circulation. Br J Anaesth 1999; 82: 813.CrossRefGoogle ScholarPubMed
Redlin, M, Koster, A, Huebler, M, et al. Regional differences in tissue oxygenation during cardiopulmonary bypass for correction of congenital heart disease in neonates and small infants: relevance of near-infrared spectroscopy. J Thorac Cardiovasc Surg 2008; 136: 962967.CrossRefGoogle ScholarPubMed
Giller, CA, Bowman, G, Dyer, H, Mootz, L, Krippner, W. Cerebral arterial diameters during changes in blood pressure and carbon dioxide during craniotomy. Neurosurgery 1993; 32: 737741; discussion 741–742.CrossRefGoogle ScholarPubMed
Valdueza, JM, Balzer, JO, Villringer, A, Vogl, TJ, Kutter, R, Einhäupl, KM. Changes in blood flow velocity and diameter of the middle cerebral artery during hyperventilation: assessment with MR and transcranial Doppler sonography. AJNR Am J Neuroradiol 1997; 18: 19291934.Google ScholarPubMed
Karsli, C, Luginbuehl, I, Farrar, M, Bissonnette, B. Cerebrovascular carbon dioxide reactivity in children anaesthetized with propofol. Paediatr Anaesth 2003; 13: 2631.CrossRefGoogle ScholarPubMed