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Anesth Analg. 2009 Apr;108(4):1122-31. doi: 10.1213/ane.0b013e318199dcd2.

Cerebral oximetry during infant cardiac surgery: evaluation and relationship to early postoperative outcome.

Author information

1
Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA. barry.kussman@childrens.harvard.edu

Abstract

BACKGROUND:

We examined changes in cerebral oxygen saturation during infant heart surgery and its relationship to anatomic diagnosis and early outcome.

METHODS:

Regional cerebral oxygen saturation (rSO(2)) was measured by near-infrared spectroscopy in 104 infants undergoing biventricular repair without aortic arch obstruction as part of a randomized trial of hemodilution to a hematocrit of 25% vs 35%.

RESULTS:

Before cardiopulmonary bypass (CPB), infants with tetralogy of Fallot had higher rSO(2) values compared to those with D-transposition of the great arteries (D-TGA) or ventricular septal defect (P < 0.001). During CPB cooling, low flow, and at the termination of CPB, D-TGA subjects had the highest rSO(2) values (P < 0.001). There were no significant associations between intraoperative rSO(2) and early postoperative outcomes after adjustment for diagnosis. In 39 D-TGA subjects with > or =5 min of deep hypothermic circulatory arrest (DHCA), there was no correlation between the rSO(2) (91% +/- 6%) or hematocrit (29.2% +/- 5.5%) at the onset of arrest and the rate of decline in rSO(2) during arrest.

CONCLUSIONS:

Intraoperative rSO(2) varies according to anatomic diagnosis but accounts for very little of the variance in early outcome. As measured by frontal near-infrared spectroscopy, higher levels of hematocrit and current perfusion techniques appear to provide an adequate oxygen reservoir prior to relatively short periods of DHCA.

PMID:
19299774
PMCID:
PMC2782610
DOI:
10.1213/ane.0b013e318199dcd2
[Indexed for MEDLINE]
Free PMC Article

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