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PEDIATRIC ANESTHESIOLOGY

Cerebral Oximetry During Infant Cardiac Surgery: Evaluation and Relationship to Early Postoperative Outcome

Barry D. Kussman, MBBCh^*, David Wypij, PhD^||, James A. DiNardo, MD^*, Jane W. Newburger, MD, MPH^¶, John E. Mayer, Jr, MD^#**, Pedro J. del Nido, MD^#**, Emile A. Bacha, MD^#**, Frank Pigula, MD^#**, Ellen McGrath, RN^¶, Peter C. Laussen, MBBS^*¶, and Section Editor Peter J. Davis

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston; Department of Anaesthesia, Harvard Medical School; Department of Cardiology, Children’s Hospital Boston; Department of Pediatrics, Harvard Medical School; ||Department of Biostatistics, Harvard School of Public Health; ¶Department of Cardiology, Harvard Medical School; #Department of Cardiovascular Surgery, Children’s Hospital Boston; and **Department of Surgery, Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Barry D. Kussman, MBBCh, Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115. Address e-mail to barry.kussman{at}childrens.harvard.edu.

Abstract

BACKGROUND: We examined changes in cerebral oxygen saturation during infant heart surgery and its relationship to anatomic diagnosis and early outcome.

METHODS: Regional cerebral oxygen saturation (rSO₂) was measured by near-infrared spectroscopy in 104 infants undergoing biventricular repair without aortic arch obstruction as part of a randomized trial of hemodilution to a hematocrit of 25% vs 35%.

RESULTS: Before cardiopulmonary bypass (CPB), infants with tetralogy of Fallot had higher rSO₂ values compared to those with D-transposition of the great arteries (D-TGA) or ventricular septal defect (P < 0.001). During CPB cooling, low flow, and at the termination of CPB, D-TGA subjects had the highest rSO₂ values (P < 0.001). There were no significant associations between intraoperative rSO₂ and early postoperative outcomes after adjustment for diagnosis. In 39 D-TGA subjects with 5 min of deep hypothermic circulatory arrest (DHCA), there was no correlation between the rSO₂ (91% ± 6%) or hematocrit (29.2% ± 5.5%) at the onset of arrest and the rate of decline in rSO₂ during arrest.

CONCLUSIONS: Intraoperative rSO₂ varies according to anatomic diagnosis but accounts for very little of the variance in early outcome. As measured by frontal near-infrared spectroscopy, higher levels of hematocrit and current perfusion techniques appear to provide an adequate oxygen reservoir prior to relatively short periods of DHCA.