Abstract
ObjectiveWe examined the hypothesis that higher cerebral oxygen saturation (rSO2) during RCP is correlated with urinary output.MethodsBetween December 2002 and August 2006, 12 patients aged 3 to 61 days and weighing 2.6 to 3.4 kg underwent aortic arch repair with RCP. Urinary output and rSO2 were analyzed retrospectively. Data were assigned to either of 2 groups according to their corresponding rSO2: Group A (rSO2 ≦ 75%) and Group B (rSO2 < 75%).ResultsSeven and 5 patients were assigned to Group A and Group B, respectively.Group A was characterized by mean radial arterial pressure (37.9 ± 9.6 vs 45.8 ± 7.8 mmHg; P = 0.14) and femoral arterial pressure (6.7 ± 6.1 vs 20.8 ± 14.6 mmHg; P = 0.09) compared to Group B. However, higher urinary output during CPB (1.03 ± 1.18 vs 0.10 ± 0.15 ml·kg-1·h-1; P = 0.03). Furthermore our results indicate that a higher dose of Chlorpromazine was used in Group A (2.9 ± 1.4 vs 1.7 ± 1.0 mg/kg; P = 0.03).ConclusionHigher cerebral oxygenation may provide higher urinary output due to higher renal blood flow through collateral circulation.
Highlights
Many authors have previously reported risk factors for aortic arch reconstruction in pediatric cardiac surgery including the Norwood operation for hypoplastic left heart syndrome [1,2]
We propose the hypothesis that higher cerebral oxygen saturation during Regional cerebral perfusion (RCP) is correlated with urinary output
We studied the relationship between rSO2 and urinary output during regional low flow perfusion (RLFP), cardiopulmonary bypass (CPB) and for one day postoperatively
Summary
Many authors have previously reported risk factors for aortic arch reconstruction in pediatric cardiac surgery including the Norwood operation for hypoplastic left heart syndrome [1,2]. Regional cerebral perfusion (RCP) has been shown to provide cerebral circulatory support during arch reconstruction, minimizing or avoiding deep hypothermic circulatory arrest (DHCA). Near-infrared spectroscopy (NIRS) is used to measure the oxygen saturation of hemoglobin in the blood vessels of the frontal cerebral cortex. The chief proposed use of NIRS technology is as a realtime, noninvasive, on-line monitor of the concentration of cerebral HbO2, Hb, and oxidized Cytochrome aa. The chief proposed use of NIRS technology is as a realtime, noninvasive, on-line monitor of the concentration of cerebral HbO2, Hb, and oxidized Cytochrome aa3 It may provide an estimate of cerebral blood flow, the cerebral blood volume, and neurological functions [5]. The purpose of this study is to evaluate the protective potential of RCP via the innominate artery to supply the subdiaphragmatic parts of the body
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