Changes in cerebral oxygenation based on intraoperative ventilation strategy

Elisabeth Dewhirst,1 Hina Walia,1 Walter P Samora,2 Allan C Beebe,2 Jan E Klamar,2 Joseph D Tobias1,3 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Orthopedic Surgery, Nationwide Children’s Hospital, The Ohio St...

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Autores principales:	Dewhirst E, Walia H, Samora WP, Beebe AC, Klamar JE, Tobias JD
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Cerebral oxygenation Near Infra-red spectroscopy NIRS Intraoperative Hyperventilation Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/4ffcae386dd24d968111bc7b67f87744
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spelling	oai:doaj.org-article:4ffcae386dd24d968111bc7b67f877442021-12-02T02:53:13ZChanges in cerebral oxygenation based on intraoperative ventilation strategy1179-1470https://doaj.org/article/4ffcae386dd24d968111bc7b67f877442018-07-01T00:00:00Zhttps://www.dovepress.com/changes-in-cerebral-oxygenation-based-on-intraoperative-ventilation-st-peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Elisabeth Dewhirst,1 Hina Walia,1 Walter P Samora,2 Allan C Beebe,2 Jan E Klamar,2 Joseph D Tobias1,3 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Orthopedic Surgery, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA; 3Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA Introduction: Cerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO2) using near-infrared spectroscopy (NIRS). Changes in rSO2 have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation. The aim of this study was to evaluate the changes in rSO2 during intraoperative changes in mechanical ventilation. Patients and methods: Following the approval of the institutional review board (IRB), tissue and cerebral oxygenation were monitored intraoperatively using NIRS. Prior to anesthetic induction, the NIRS monitor was placed on the forehead and over the deltoid muscle to obtain baseline values. NIRS measurements were recorded each minute over a 5-min period during general anesthesia at four phases of ventilation: 1) normocarbia (35–40 mmHg) with a low fraction of inspired oxygen (FiO2) of 0.3; 2) hypocarbia (25–30 mmHg) and low FiO2 of 0.3; 3) hypocarbia and a high FiO2 of 0.6; and 4) normocarbia and a high FiO2. NIRS measurements during each phase were compared with sequential phases using paired t-tests. Results: The study cohort included 30 adolescents. Baseline cerebral and tissue oxygenation were 81% ± 9% and 87% ± 5%, respectively. During phase 1, cerebral rSO2 was 83% ± 8%, which decreased to 79% ± 8% in phase 2 (hypocarbia and low FiO2). Cerebral oxygenation partially recovered during phase 3 (81% ± 9%) with the increase in FiO2 and then returned to baseline during phase 4 (83% ± 8%). Each sequential change (e.g., phase 1 to phase 2) in cerebral oxygenation was statistically significant (p < 0.01). Tissue oxygenation remained at 87%–88% throughout the study. Conclusion: Cerebral oxygenation declined slightly during general anesthesia with the transition from normocarbia to hypocarbic conditions. The rSO2 decrease related to hypocarbia was easily reversed with a return to baseline values by the administration of supplemental oxygen (60% vs. 30%). Keywords: pediatric, cerebral oxygenation, near infrared spectroscopy (nirs), intraoperative, ventilationDewhirst EWalia HSamora WPBeebe ACKlamar JETobias JDDove Medical PressarticleCerebral oxygenation Near Infra-red spectroscopy NIRS Intraoperative HyperventilationMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol Volume 11, Pp 253-258 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cerebral oxygenation Near Infra-red spectroscopy NIRS Intraoperative Hyperventilation Medical technology R855-855.5
spellingShingle	Cerebral oxygenation Near Infra-red spectroscopy NIRS Intraoperative Hyperventilation Medical technology R855-855.5 Dewhirst E Walia H Samora WP Beebe AC Klamar JE Tobias JD Changes in cerebral oxygenation based on intraoperative ventilation strategy
description	Elisabeth Dewhirst,1 Hina Walia,1 Walter P Samora,2 Allan C Beebe,2 Jan E Klamar,2 Joseph D Tobias1,3 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Orthopedic Surgery, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA; 3Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA Introduction: Cerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO2) using near-infrared spectroscopy (NIRS). Changes in rSO2 have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation. The aim of this study was to evaluate the changes in rSO2 during intraoperative changes in mechanical ventilation. Patients and methods: Following the approval of the institutional review board (IRB), tissue and cerebral oxygenation were monitored intraoperatively using NIRS. Prior to anesthetic induction, the NIRS monitor was placed on the forehead and over the deltoid muscle to obtain baseline values. NIRS measurements were recorded each minute over a 5-min period during general anesthesia at four phases of ventilation: 1) normocarbia (35–40 mmHg) with a low fraction of inspired oxygen (FiO2) of 0.3; 2) hypocarbia (25–30 mmHg) and low FiO2 of 0.3; 3) hypocarbia and a high FiO2 of 0.6; and 4) normocarbia and a high FiO2. NIRS measurements during each phase were compared with sequential phases using paired t-tests. Results: The study cohort included 30 adolescents. Baseline cerebral and tissue oxygenation were 81% ± 9% and 87% ± 5%, respectively. During phase 1, cerebral rSO2 was 83% ± 8%, which decreased to 79% ± 8% in phase 2 (hypocarbia and low FiO2). Cerebral oxygenation partially recovered during phase 3 (81% ± 9%) with the increase in FiO2 and then returned to baseline during phase 4 (83% ± 8%). Each sequential change (e.g., phase 1 to phase 2) in cerebral oxygenation was statistically significant (p < 0.01). Tissue oxygenation remained at 87%–88% throughout the study. Conclusion: Cerebral oxygenation declined slightly during general anesthesia with the transition from normocarbia to hypocarbic conditions. The rSO2 decrease related to hypocarbia was easily reversed with a return to baseline values by the administration of supplemental oxygen (60% vs. 30%). Keywords: pediatric, cerebral oxygenation, near infrared spectroscopy (nirs), intraoperative, ventilation
format	article
author	Dewhirst E Walia H Samora WP Beebe AC Klamar JE Tobias JD
author_facet	Dewhirst E Walia H Samora WP Beebe AC Klamar JE Tobias JD
author_sort	Dewhirst E
title	Changes in cerebral oxygenation based on intraoperative ventilation strategy
title_short	Changes in cerebral oxygenation based on intraoperative ventilation strategy
title_full	Changes in cerebral oxygenation based on intraoperative ventilation strategy
title_fullStr	Changes in cerebral oxygenation based on intraoperative ventilation strategy
title_full_unstemmed	Changes in cerebral oxygenation based on intraoperative ventilation strategy
title_sort	changes in cerebral oxygenation based on intraoperative ventilation strategy
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/4ffcae386dd24d968111bc7b67f87744
work_keys_str_mv	AT dewhirste changesincerebraloxygenationbasedonintraoperativeventilationstrategy AT waliah changesincerebraloxygenationbasedonintraoperativeventilationstrategy AT samorawp changesincerebraloxygenationbasedonintraoperativeventilationstrategy AT beebeac changesincerebraloxygenationbasedonintraoperativeventilationstrategy AT klamarje changesincerebraloxygenationbasedonintraoperativeventilationstrategy AT tobiasjd changesincerebraloxygenationbasedonintraoperativeventilationstrategy
_version_	1718402041066291200

Changes in cerebral oxygenation based on intraoperative ventilation strategy

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