The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants
Abstract Background Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide e...
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BMC
2021-11-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-021-01498-0 |
| _version_ | 1831677184691929088 |
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| author | Li Zhang Lu Liu Zhiqiu Zhong Hengfang Jin Jian Jia Lingzhong Meng Xuming Mo Xiaohua Shi |
| author_facet | Li Zhang Lu Liu Zhiqiu Zhong Hengfang Jin Jian Jia Lingzhong Meng Xuming Mo Xiaohua Shi |
| author_sort | Li Zhang |
| collection | DOAJ |
| description | Abstract Background Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion. Methods Neonates/infants who were scheduled for aortic coarctation repair with cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) from January 2015 to February 2017 in Children’s Hospital of Nanjing Medical University participated in this prospective observational study. Cerebral and somatic tissue oxygen saturation (SctO2 and SstO2) were monitored on the forehead and at the thoracolumbar paraspinal region, respectively. SctO2 and SstO2 were recorded at different time points (baseline, skin incision, CPB start, SCP start, SCP end, aortic opening, CPB end, and surgery end). SctO2 and SstO2 were correlated with mean arterial pressure (MAP) and partial pressure of arterial blood carbon dioxide (PaCO2). Results Data of 21 patients were analyzed (age=75±67 days, body weight=4.4±1.0 kg). SstO2 was significantly lower than SctO2 before aortic opening and significantly higher than SctO2 after aortic opening. SstO2 correlated with leg MAP when the measurements during SCP were (r=0.67, p<0.0001) and were not included (r=0.46, p<0.0001); in contrast, SctO2 correlated with arm MAP only when the measurements during SCP were excluded (r=0.14, p=0.08 vs. r=0.66, p<0.0001). SCP also confounded SctO2/SstO2’s correlation with PaCO2; when the measurements during SCP were excluded, SctO2 positively correlated with PaCO2 (r=0.65, p<0.0001), while SstO2 negatively correlated with PaCO2 (r=-0.53, p<0.0001). Conclusions SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied. |
| first_indexed | 2024-12-20T04:37:06Z |
| format | Article |
| id | doaj.art-f1ad93b18b404453b047412f2fcbe500 |
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| language | English |
| last_indexed | 2024-12-20T04:37:06Z |
| publishDate | 2021-11-01 |
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| spelling | doaj.art-f1ad93b18b404453b047412f2fcbe5002022-12-21T19:53:14ZengBMCBMC Anesthesiology1471-22532021-11-012111910.1186/s12871-021-01498-0The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infantsLi Zhang0Lu Liu1Zhiqiu Zhong2Hengfang Jin3Jian Jia4Lingzhong Meng5Xuming Mo6Xiaohua Shi7Department of Anesthesiology, Children’s Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Children’s Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Children’s Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Children’s Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Children’s Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Yale University School of MedicineDepartment of Cardiothoracic, Children’s Hospital of Nanjing Medical UniversityDepartment of Anesthesiology, Children’s Hospital of Nanjing Medical UniversityAbstract Background Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion. Methods Neonates/infants who were scheduled for aortic coarctation repair with cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) from January 2015 to February 2017 in Children’s Hospital of Nanjing Medical University participated in this prospective observational study. Cerebral and somatic tissue oxygen saturation (SctO2 and SstO2) were monitored on the forehead and at the thoracolumbar paraspinal region, respectively. SctO2 and SstO2 were recorded at different time points (baseline, skin incision, CPB start, SCP start, SCP end, aortic opening, CPB end, and surgery end). SctO2 and SstO2 were correlated with mean arterial pressure (MAP) and partial pressure of arterial blood carbon dioxide (PaCO2). Results Data of 21 patients were analyzed (age=75±67 days, body weight=4.4±1.0 kg). SstO2 was significantly lower than SctO2 before aortic opening and significantly higher than SctO2 after aortic opening. SstO2 correlated with leg MAP when the measurements during SCP were (r=0.67, p<0.0001) and were not included (r=0.46, p<0.0001); in contrast, SctO2 correlated with arm MAP only when the measurements during SCP were excluded (r=0.14, p=0.08 vs. r=0.66, p<0.0001). SCP also confounded SctO2/SstO2’s correlation with PaCO2; when the measurements during SCP were excluded, SctO2 positively correlated with PaCO2 (r=0.65, p<0.0001), while SstO2 negatively correlated with PaCO2 (r=-0.53, p<0.0001). Conclusions SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied.https://doi.org/10.1186/s12871-021-01498-0Neonates and infantsAortic coarctation repairCerebral tissue oxygen saturationSomatic tissue oxygen saturation, prospective cohort study |
| spellingShingle | Li Zhang Lu Liu Zhiqiu Zhong Hengfang Jin Jian Jia Lingzhong Meng Xuming Mo Xiaohua Shi The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants BMC Anesthesiology Neonates and infants Aortic coarctation repair Cerebral tissue oxygen saturation Somatic tissue oxygen saturation, prospective cohort study |
| title | The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants |
| title_full | The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants |
| title_fullStr | The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants |
| title_full_unstemmed | The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants |
| title_short | The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants |
| title_sort | effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants |
| topic | Neonates and infants Aortic coarctation repair Cerebral tissue oxygen saturation Somatic tissue oxygen saturation, prospective cohort study |
| url | https://doi.org/10.1186/s12871-021-01498-0 |
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