Monitoring and managing cerebral oxygen saturation by using NIRS : Searching for predictive factors and riskfactors

Menger, N.A. (2015) Monitoring and managing cerebral oxygen saturation by using NIRS : Searching for predictive factors and riskfactors. thesis, Medicine.

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Abstract

Introduction: Infants undergoing a surgical procedure in their first months of live, have more often a neurodevelopmental impairment at later age compared to infants not having surgery. They showed a cognitive developmental delay as well as a behavourial delay and/ or cerebral palsy. Probably the cause of this neurodevelopmental delay is multifactorial. The starting position of the infant as well as the surgery itself could have some influence. Experimental and clinical studies showed a toxicity of anaesthesia on neurotransmitter responses. Thereby an increasing evidence suggested anaesthesia to influence systemical parameters. These changes might lead to brain injury. Mostly it concerns periventriculair leukomalacia of the white matter. Providing an optimal cerebral saturation (ScO2) is the cornerstone of peri-operative neonatal care. This can be established by an adequate blood flow to the brain and/ or an adequate oxygen saturation. The objective of this study was to determine the incidence of cerebral desaturation in neonates during a surgical procedure under general anaesthesia, measured by near-infrared spectroscopy (NIRS). Thereby we searched for risk- or predictive factors for the development of cerebral desaturation. Materials and Methode: Infants in the age of 0 – 6 months, undergoing a surgical procedure under general anaesthesia, were included. Cerebral oxygen saturation was measured by using near-infraredspectroscopy (NIRS). Pre-operative the haemoglobin and glucose levels were measured. During surgery standard care was provided. Along with the ScO2 values also the systemical parameters blood pressure (MAP), heartrate, periferal saturation (SpO2) and etCO2 were monitored. Events during the surgerical procedure were noted. Cerebral desaturation was defined as a ScO2 < 55%. Results: 80 Neonates were included with a mean age of 41 ± 8 weeks. 19 Neonates developed cerebral desaturation. The two groups desaturation/ no desaturation differed significantly, these included age, weight, pre-operative Hb and ASA-classe (p< .05). Mortality and morbidity was also greater in the desaturation group (47% vs 5%). Age, Hb and ASA-classe showed a significant correlation with ScO2 (p< .05). MAP and glucose were significantly correlated with ScO2 at p < .10. Neonates undergoing surgery for KASAI or a laparotomy had significant lower values of ScO2 compared to laparoscopic pyloromyotomy. Conclusion: The incidence of cerebral desaturation decreased from 2012 till 2014 with 11%. Low age or low pre-operative Hb levels could be possible riskfactors for the development of cerebral desaturation. Blood pressure is a less reliable factor for the prediction of desaturation. Monitoring of cerebral saturation is still the best method for the detection of cerebral desaturation. Further study with larger sample size is needed to design a conclusive prediction model. Beside that follow-up studies are required to investig

Item Type:	Thesis (Thesis)
Supervisor name:	Facultaire begeleider: and Absalom, Prof. Dr. and Dagelijks begeleider: and Bergsma-Brouwer, Drs. and Universitair Medisch Centrum Groningen, Anesthesiologie
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:42
Last Modified:	25 Jun 2020 10:42
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/363

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