Cerebral ischaemia during cardiac surgery in children detected by combined monitoring of BIS and near-infrared spectroscopy

• Published in: British journal of anaesthesia : BJA Vol. 92; no. 5; pp. 662 - 669
• Main Authors: Hayashida, M., Kin, N., Tomioka, T., Orii, R., Sekiyama, H., Usui, H., Chinzei, M., Hanaoka, K.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.2004; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adolescent; Age Factors; anaesthesia; anaesthesia, paediatric; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; bispectral index; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Cardiopulmonary Bypass; cerebral ischaemia; Child; Child, Preschool; complications; complications, cerebral ischaemia; electroencephalography; Electroencephalography - methods; Female; Heart Defects, Congenital - surgery; Humans; Hypotension - complications; Infant; Intraoperative Complications - diagnosis; Male; measurement techniques; measurement techniques, near-infrared spectroscopy; Medical sciences; monitoring; monitoring, bispectral index; monitoring, electroencephalography; Monitoring, Intraoperative - methods; near‐infrared spectroscopy; paediatric; Risk Factors; Spectroscopy, Near-Infrared - methods; complications, cerebral ischaemia; monitoring, bispectral index; monitoring, electroencephalography; measurement techniques, near-infrared spectroscopy; anaesthesia, paediatric; anaesthesia, paediatric; complications, cerebral ischaemia; measurement techniques, near‐infrared spectroscopy; monitoring, bispectral index; monitoring, electroencephalography; Heart; Central nervous system; Electrophysiology; Cardiovascular disease; Encephalon; Vascular disease; Ischemia; Surgery; Arterial pressure; Blood pressure; Child; Age; Monitoring; near-infrared spectroscopy; monitoring; Human; electroencephalography; paediatric; complications; Nervous system diseases; Oxygen; Acute; Saturation; Cyanotic heart disease; Transitory; cerebral ischaemia; measurement techniques; Cardiopulmonary bypass; Arterial blood; bispectral index; monitoring; Self regulation; Circulatory system; Hemodynamics; anaesthesia
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aeh120

Children frequently suffer transient cerebral ischaemia during cardiac surgery. We measured cerebral ischaemia in children during cardiac surgery by combining two methods of monitoring. We studied 65 children aged between 5 months and 17 yr having surgery to correct non-cyanotic heart disease using hypothermic cardiopulmonary bypass (CPB). During surgery, we measured the Bispectral Index (BIS) and regional cerebral haemoglobin oxygen saturation (SrO2) with near-infrared spectroscopy (NIRS). Cerebral ischaemia was diagnosed if both SrO2 and BIS decreased abruptly when acute hypotension occurred. In each patient, the relationship between SrO2 and arterial blood pressure (AP) was indicated by a plot of mean SrO2 against simultaneous mean AP. We noted 72 episodes of cerebral ischaemia in 38 patients. Sixty-three ischaemic events were during CPB. Cerebral ischaemia was less frequent in older patients. Cerebral ischaemia was more common and more frequent in children under 4 yr old. Haematocrit during CPB was lower and SrO2 was more dependent on AP in children under 4 yr. Children less than 4 yr of age are more likely to have cerebral ischaemia caused by hypotension during cardiac surgery. Ineffective cerebral autoregulation and haemodilution during CPB may be responsible.