Petrykiv, S.I. (2013) Monitoring van de cerebrale saturatie middels NIRS bij neonaten in de operatieve setting. thesis, Medicine.
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Abstract
Background: Cerebral disorders form one of the major problems of neonates. Etiology of encephalopathy is a multifactorial phenomenon and is often associated with disorders of cerebral autoregulation. Still little is known about physiology and pathophysiology of cerebral autoregulation in neonates. There are few existing studies about differences in cerebral autoregulation between children and adults and about the limits of autoregulation. It is not known which children are most at risk of cerebral dysautoregulation. Long time measurements of cerebral circulation were hindered by practical difficulties but since the appearance of new measuring devices it became possible to monitor the cerebral tissue oxygenation continuously and not invasively. Existing studies on cerebral autoregulation in neonates include a limited group of patients, particularly from the cardiac and IC studies. Studies on the cerebral saturation in neonates in the operative setting are not known to us. Aim: To describe the course of cerebral tissue oxygenation during a surgical procedure and to examine the factors disturbing it. To identify the risk factors for cerebral desaturation and dysautoregulation, to identify the boundaries beyond which the cerebral autoregulation disturbs. Method: In this prospective observational study, neonates were enrolled who underwent a surgical procedure under general anesthesia. During the procedure the measurements of rScO2, MAP, SatO2, FiO2, etCO2, HR and all the events were done. The course of cerebral desaturations was examined, the autoregulation limits were determined. Results: Episodes of cerebral desaturation occurred in 11 (37%) neonates, accounted for 5% of all measurements and showed a wide inter-and intra-individual variation of 24% to 99%. The average duration of cerebral desaturation was 794 seconds and accured 1-3 times per operation. Hypoxic hypoxemia was the main cause of cerebral desaturations. and it occurred even in various stages of operation. Observed subjects with cerebral desaturation had a younger age, lower weight, a higher incidence of respiratory and neurological deficiencies preoperatively. Children with low rScO2 received at the ICU more often a combination therapy, they had a higher ASA score, during surgery there were more anesthetic complications and there was a high mortality. We found coherence> 0.4 between the MAP and rScO2 was found in 11 (37%) neonates. This group was characterized by a younger age, lower weight, respiratory and neurological deficiencies preoperatively, combination therapy in the ICU, and higher ASA score. The neonates with pressure-dependent cerebral blood flow had a higher incidence of anesthetic complications, cerebral desaturations, use of inotropic support and a higher mortality. The average LLA in our cohort of neonates was 28.7 mm Hg. Conclusion: The cerebral desaturation in neonates in the surgical setting is a common phenomenon. The cerebral desaturation occurs in the group of susceptible children usually due to hypoxic hypoxemia. The blood pressure-dependent cerebral blood flow was measured at a mean MAP </ = 28.7 mm Hg.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Absalom, Dr. Prof. A.R. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1486 |
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