Let us save the brain with cerebral oximeter: Two case reports

Abstract

In the neonates, tracheal atresia and tracheoesophageal fistula (TEF) surgery may result in hemodynamic instabilization, leading to cerebral perfusion insufficiency due to the retraction of the pulmonary vessels and truncus brachiocephalicus. We represented one male and one female neonates which were performed thoracoscopic primary repair of TEF through right thoracotomy at the 3^th and 4^th postpartum day. Anesthesia was induced using sodium thiopental (5 mg/kg), fentanyl 4 mcg, and rocuronium (0.5 mg/kg) given through intravenous route. Sevoflurane 2% and 50% O₂in air were used for the maintenance therapy. During the right lung compression to expose posterior esophagus, no value was observed on the pulse oximeter (PO) probe placed on the right hand, and radial artery was not palpated. At the same time, oxygen saturation was observed as 96%-97% on the left foot probe. As the right cerebral oximeter values (rSO₂) were rapidly decreased to 31%, the lung compression was ceased. Right pulse oximeter and right rSO₂measurements return to the baseline levels. For the second case - different from the first case -both left and right rSO₂was rapidly decreased to 40% levels and return to the baseline levels after was removed the retractors. Right PO and right and left cerebral rSO₂values returned to baseline immediately when the retractor compression was ended During the operations involving the great vessels in neonates, cerebral perfusion could be preserved using cerebral oximeter. Cerebral oximeter is more efficient than pulse oximeter for detecting cerebral tissue oxygenation and could be helpful to minimize neuronal damage in the neonates.

Keywords: Anesthesia; esophageal atresia; near-infrared spectroscopy; neonatal surgery; tracheoesophageal fistula.

Figure 1

Position of the cases during procedures

Figure 2

Case 1 shows decrease of the cerebral oximeter values of the right hemisphere during the compression of the lung in the case 1. Values returned to the baseline values after the compression was ceased. Channel 1 left, channel 2 right cerebral oximeter value changes during the procedure (CH1: Yellow line, CH2: Blue line)

Figure 3

Case 2 shows decrease of the cerebral oximeter values of both of two hemispheres during the compression of the lung in the case 2. Values returned to the baseline values after the compression was ceased. Channel 1 left cerebral oximeter value changes during the procedure (CH1: Yellow line). Channel 2 right cerebral oximeter value changes during the procedure (CH2: Blue line)