CEREBRAL OXIMETRY AS A NEUROMONITORING TECHNIQUE DURING ORAL SANATION IN CHILDREN UNDER GENERAL ANESTHESIA ON AN OUTPATIENT BASIS

Abstract

The article presents the results of assessing cerebral metabolism in children during oral cavity sanitation under conditions of general anaesthesia on an outpatient basis. The procedure was performed by using a non-invasive technique of neuromonitoring, cerebral oximetry, aimed at detecting changes in the cerebral oxygen supply. The method of cerebral oximetry enables to diagnose reduced oxygen saturation of cerebral tissues in early stage that significantly cuts down the risk of pathological organic changes in the brain and, as a consequence, decreases the risk of functional postoperative changes. It is noteworthy that rSO2 is within the upper normal limit (74.41% ± 2.08). This is explained by the peculiarities of the circulatory system in children and vascular walls in particular (developed capillary network, elasticity, and vascular permeability), as well as by the characteristics of the structure of the brain and increased oxygen consumption by cerebral neurons, which are in the stage of active development. It is important to stress that this figure is within the upper normal limit due to ↓rSO2 by 9.4% at the preoperative stage that can be explained by the high stressing, which in most cases is associated with "cryptogenic" phobias. This is a reasonable premise for administering anxiolytics prior dental intervention under general anaesthesia in an outpatient setting to avoid sharp fluctuations in cerebral oxygen saturation. The specific weight of ↓rSO2 in the preoperative stage in group of children is ↓ rSO2 (67.21%) in 24 (17.4%) children (7.18% relative to the total indicator of the identical group and 9.67% relative to the general group), who were at the renewal treated due to acute conditions (acute pulpitis, exacerbation of chronic periodontitis, periostitis). The period between dental interventions in these children did not exceed 2 weeks. This fact causes the necessity to limit the period of recurrent dental interventions to not less than two weeks. According to the results of the study, it has been found out that dental care under general anaesthesia on an outpatient basis while maintaining spontaneous breathing has time limits. It is advisable to perform general anaesthesia for 30 ± 10 minutes in children aged 0-3 years, for 40 ± 15 min. in children aged 3-12 years, and 60 ± 15 min. in children aged 12-18 years. The choice of dental treatment modes should be based on the time and possibility of a second visit. The term of planned dental surgery under general anaesthesia in an outpatient setting while maintaining spontaneous breathing after acute respiratory diseases requires at least two week period. In order to prevent the risk of complications during the oral sanitation at an outpatient setting under general anaesthesia, a period of scheduled dental recurrent interventions should be preformed not earlier than in two weeks.