Background

Both the brain immaturity of a child undergoing congenital heart surgery and the complexity of surgical procedures increase the risk of brain injury and development of adverse neurological outcomes. The brain remains the most vulnerable organ and the reason of concern of many pediatric cardiac anesthesiologists. Cerebral oximetry by using the INVOS has an important role in early detection of cerebral hypoperfusion.

The aim of this study is to present our experience and review the benefits of cerebral oximetry in pediatric patients.

Key words: cerebral oximetry, pediatric cardiac surgery, in-vivo optical spectroscopy, high risk patients

Methods

Our observational retrospective study included 116 patients who underwent surgery of congenital heart disease at the University Clinical Center of Sarajevo. The data of invasive hemodynamic monitoring and bilateral cerebral oxygen saturation (rSO2) intraoperatively measured by the INVOS device were collected from patients’ records.

Results

Out of 116 patients 50.9% were female. The average age was 21 months, the oldest child being 14, 13% were newborns, 12% toddlers, 39% infants age 1 to 3, and 36% above the age of 3. Complex congenital anomalies prevailed with 28%, VSD 23% followed by ASD 14%. Fallot’s tetralogy was the most common cyanotic anomaly in 11% of patients. The curve trends and numerical values of rSO2 showed significant decline from the baseline values in correlation with a decrease of arterial blood pressure and peripheral oxygen saturation. The left/right discrepancy showed lower values of rSO2 on the left brain hemisphere, which is in correlation with literature data. No lethal outcomes and early postoperative neurological deficits were recorded.

Conclusion

The new era of neuromonitoring in pediatric cardiac surgery has shown potential benefits for the use of cerebral oximetry in high risk pediatric patients.

Corresponding author:
Sanja Granov Grabovica
Clinic for Cardiovascular Surgery
Department of Cardiac Anesthesia and Intensive Care Unit
University Clinical Center of Sarajevo,
Bolnička 25, 71000 Sarajevo, Bosnia and Hercegovina
Phone : ++387 61 348 353
e-mail: sanjagranov@hotmail.com

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