Is Bilateral Monitoring of Cerebral Oxygen Saturation Necessary During Neonatal Aortic Arch Reconstruction?

• Published in: Anesthesia and analgesia Vol. 98; no. 5; pp. 1267 - 1272
• Main Authors: Andropoulos, Dean B, Diaz, Laura K, Fraser, Charles D, McKenzie, E Dean, Stayer, Stephen A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.05.2004; Lippincott
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta, Thoracic - surgery; Biological and medical sciences; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cerebrovascular Circulation - physiology; Female; Functional Laterality - physiology; Humans; Infant, Newborn; Male; Medical sciences; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - physiology; Monitoring, Intraoperative; Oxygen Consumption - physiology; Perfusion; Polytetrafluoroethylene; Reconstructive Surgical Procedures; Software; Spectroscopy, Near-Infrared; Ultrasonography, Doppler, Transcranial; Human; Oxygen; Newborn; Aortic arch; Saturation; Anesthesia; Monitoring; Encephalon
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000111114.48702.59

In this study, we measured cerebral oxygenation in both cerebral hemispheres by using near-infrared spectroscopy before, during, and after regional low-flow cerebral perfusion (RLFP) to determine whether bilateral monitoring was necessary. Neonates undergoing aortic arch reconstruction with RLFP were studied. The bilateral regional cerebral oxygenation index was measured and recorded at 1-min intervals during the following periods1) before bypass, 2) during bypass before RLFP, 3) during RLFP, 4) on bypass after RLFP, and 5) post-bypass. Before bypass and on bypass before RLFP, the correlation (r = 0.979 and 0.852) and agreement (mean bias, right versus left, 0 and +2) between hemispheres were excellent. During RLFP, however, correlation (r = 0.35) and agreement (mean bias of the right versus left side, +6.3) worsened and only partially returned to baseline values after RLFP. Nine of 19 patients had sustained differences in cerebral oxygen saturation of >10%, always with the left side values less than the right. Bilateral monitoring detects desaturation in the left cerebral hemisphere during RLFP. The long-term consequences of lower saturations on the left side of the brain are unclear.