Relationship between cerebral oxygen saturation and hemodynamics under different end-tidal carbon dioxide partial pressure in children with ventricular septal defect

Abstract

Objective To study the relationship between regional cerebral tissue oxygen saturation (rScO2) and hemodynamic parameters under different end-tidal carbon dioxide partial pressure (PetCO2) levels during anesthesia induction period in children undergoing ventricular septal defect(VSD) repair. Methods A total of 25 patients aged from 2 to 37 months (median 6 months) were enrolled, who received selective VSD repair at Beijing Anzhen Hospital from April to May 2017.After admission, anesthesia induction and intubation, invasive radial artery pressure were established routinely and hemodynamic device-MostCare was used, Fore-Sight was used to monitor rScO2 of the right frontal brain.By means of adjusting mechanical ventilation parameter, PetCO2 was maintained at 30 (T1), 35 (T2), 40 (T2), 45 (T3) mmHg(1 mmHg=0.133 kPa) in sequence.Pulse oxygen saturation (SpO2), heart rate (HR), systolic pressure (SysP), difference between dicrotic pressure(DicP) and diastolic pressure(DiaP) (Pdic-a), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), and pulse pressure variation (PPV) were recorded at T1, T2, T3 and T4. Results (1) Comparison among groups: rScO2 at T4, T3, T2 and T1 were(80.5±4.0)%, (78.2±4.6)%, (74.4±5.7)%, (70.8±6.5)%, respectively, rScO2 at T2, T3 and T4 were higher than that at T1, and the differences were statistically significant (all P 0.05). Conclusions During anesthesia induction in ventricular septal defect children, rScO2 increases significantly with the increase in PetCO2.When PetCO2 is at 30 and 35 mmHg, rScO2 is mainly affected by hemodynamics.When PetCO2 is at 40 and 45 mmHg, rScO2 is mainly affected by PetCO2, but less affected by hemodynamics. Key words: Congenital heart disease; Cerebral oxygen saturation; Hemodynamics; End-tidal carbon dioxide