Features of noninvasive cerebral oximetry and central hemodynamics in young children with hydrocephalus

O.S. Pavlysh,V.I. Snisar

doi:10.26641/2307-0404.2021.3.242093

Abstract

Hydrocephalus is one of the most common diseases of the nervous system in young children. Features of structural and morphological changes of the brain in children with hydrocephalus are the predominance of signs of periventricular ischemia of brain tissue due to cerebral circulatory disorders. Despite the existence of a large number of methods for assessing cerebral hemodynamics, in the modern literature there is only limited information about the oxygen status of the brain when using different types of anesthesia in children. The aim of the study was to assess the dynamics of noninvasive cerebral oximetry and central hemodynamics in young children with hydrocephalus during ventriculoperitoneal shunting. The research included 59 young children with acquired hydrocephalus who underwent ventriculoperitoneal shunting. 34 children underwent total intravenous anesthesia with propofol, 25 children – total inhalation anesthesia with sevoflurane. Intraoperative control of vital functions of the patient was performed: systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, regional saturation, carbon dioxide level on exhalation, sevoflurane concentration on inspiration and exhalation, non-invasive cerebral indicators. Children with acquired hydrocephalus had cerebral oximetry within normal regional level. The use of sevoflurane leads to increased cerebral oxygenation by inhibiting cerebral metabolic needs for oxygen and vasodilation of blood vessels with increased cerebral blood flow. Total intravenous anesthesia does not change the rate of intraoperative cerebral oxygenation, leads to hemodynamic changes in the form of decreased stroke volume, which may indicate that propofol reduces the level of oxygen consumption by the brain with decreased cerebral blood flow against the background of hemodynamic inhibition.

Highlights

IntroductionОсобливості показників неінвазивної церебральної оксиметрії та центральної гемодинаміки в дітей раннього віку з гідроцефалією
The lack of difference with the control group of the initial rSO2 data can be explained by the fact that prolonged hypoperfusion of the cerebral substance caused by vascular spasm, combined with compression of the distended ventricles of the brain leads to disruption of membrane oxygen transport and venous outflow from the brain
The analysis of the primary condition of the cardiovascular system and in comparison with the control group, in children with acquired hydrocephalus revealed a significant increase in stroke volume (SV), cardiac output (CO) by 18.5% and 28.2%, and decrease of systemic vascular resistance (SVR) by 25.1% (Table 1), which was regarded as a hyperkinetic variation of hemodynamics

Summary

Introduction

Особливості показників неінвазивної церебральної оксиметрії та центральної гемодинаміки в дітей раннього віку з гідроцефалією. Метою роботи була оцінка динаміки показників неінвазивної церебральної оксиметрії та центральної гемодинаміки в дітей раннього віку з гідроцефалією при проведенні вентрикулоперитонеального шунтування. The method of cerebral oximetry nearinfrared reflectance spectroscopy (NIRS) is being actively implemented, the main advantages of which are informativeness, noninvasiveness and safety. In complex settings such as pediatric cardiac surgery, pediatric neurosurgery, pediatric and neonatal intensive care, NIRS is increasingly used to detect episodes of cerebral ischemia, both during surgery and in the postoperative period. Currently there are insufficient clinical data on the critical levels of measurable variables that are necessary for the safe management of the perioperative period of patients inclined to cerebral ischemia [6]

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