Abstract
BackgroundAlthough regional cerebral oxygen saturation (rScO2) monitoring has been widely used in clinical practice, the relationship between hemoglobin (dHB) content and rScO2 is incompletely understood. The aim of this study was to analyze the effect of hemoglobin content on rScO2 in pediatric patients undergoing general anesthesia for correction of scoliosis.MethodsNinety-two pediatric patients aged 3 to 14 years undergoing scoliosis correction surgery were enrolled. Continuous monitoring of bilateral regional cerebral oxygen saturation by near-infrared spectroscopy (NIRS, CASMED, USA) was performed after entering the operation room. rScO2 was recorded when the patients entered the operating room (T0, baseline), after anesthesia induced intubation (T1), and after radial artery puncture (T2). The lowest value of rScO2 during surgery was also recorded. The arterial blood pressure (ABP), heart rate (HR), pulse oxygen saturation (SpO2), end tidal carbon dioxide partial pressure (PetCO2) were continuously recorded. Patients were classified as low rScO2 or high rScO2 group according to whether the lowest intraoperative rScO2 was 15% lower than the baseline value. An analysis and comparison of differences in hemoglobin content in these two groups was carried out.ResultsThe preoperative hemoglobin-postoperative hemoglobin of patients in the high rScO2 group was significantly lower than that in the low rScO2 group (t = − 7.86, p < 0.01), the amount of bleeding during the operation was also less than that in the low rScO2 group (t = − 6.05, p < 0.01), and the systolic pressure of patients was higher than that in the low rScO2 group (t = 4.27, p < 0.01).ConclusionsThe decrease in hemoglobin level which occurs during surgery leads to a decrease in cerebral oxygen saturation. In order to ensure patient safety during surgery, it is necessary to carry out volume management and appropriate transfusion and fluid replacement in a timely manner.Trial registrationChinese Clinical Trial Registry, ChiCTR1800016359. Registered 28 May 2018.
Highlights
Regional cerebral oxygen saturation monitoring has been widely used in clinical practice, the relationship between hemoglobin content and rScO2 is incompletely understood
High regional cerebral oxygen saturation (H-rScO2) is defined as the decrease in rScO2min is no more than 15% lower than the baseline or the value of rScO2min is 15% lower than the baseline but the duration is less than 2 min
Perioperative characteristics As basic hemoglobin content differs in patients of different ages, the correlation between hemoglobin and cerebral oxygen saturation is expressed by the Preoperative hemoglobin-postoperative hemoglobin (dHB)
Summary
Regional cerebral oxygen saturation (rScO2) monitoring has been widely used in clinical practice, the relationship between hemoglobin (dHB) content and rScO2 is incompletely understood. During surgery for correction of scoliosis, there is typically an increase in bleeding when the osteotomy is carried out and pedicle screws are inserted At this time, hemoglobin may decrease significantly and hemodynamics may become unstable, and this results in high risk for cerebral desaturation due to decreased perfusion of brain tissue. Some studies have shown that cerebral hypoperfusion in infants during the perioperative period is closely related to the occurrence of postoperative neurologic complications and prolonged hospital stays [4]. At this time, most research focuses on cerebral oxygen saturation in cardiac and vascular surgery. There have been few studies on the relationship of intraoperative hemorrhage, decrease in hemoglobin and changes in cerebral oxygen saturation in correction of scoliosis in pediatric patients
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