Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz 55131, Germany
Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz 55131, Germany.
Br J Anaesth. 2016 Oct;117(4):482-488. doi: 10.1093/bja/aew250. Epub 2016 Oct 17.
Neurosurgical operations in the dorsal cranium often require the patient to be positioned in a sitting position. This can be associated with decreased cardiac output and cerebral hypoperfusion, and possibly, inadequate cerebral oxygenation. In the present study, cerebral oxygen saturation was measured during neurosurgery in the sitting position and correlated with cardiac output.
Perioperative cerebral oxygen saturation was measured continuously with two different monitors, INVOS and FORE-SIGHT. Cardiac output was measured at eight predefined time points using transoesophageal echocardiography.
Forty patients were enrolled, but only 35 (20 female) were eventually operated on in the sitting position. At the first time point, the regional cerebral oxygen saturation measured with INVOS was 70 (sd 9)%; thereafter, it increased by 0.0187% min (P<0.01). The cerebral tissue oxygen saturation measured with FORE-SIGHT started at 68 (sd 13)% and increased by 0.0142% min (P<0.01). The mean arterial blood pressure did not change. Cardiac output was between 6.3 (sd 1.3) and 7.2 (1.8) litre min at the predefined time points. Cardiac output, but not mean arterial blood pressure, showed a positive and significant correlation with cerebral oxygen saturation.
During neurosurgery in the sitting position, the cerebral oxygen saturation slowly increases and, therefore, this position seems to be safe with regard to cerebral oxygen saturation. Cerebral oxygen saturation is stable because of constant CO and MAP, while the influence of CO on cerebral oxygen saturation seems to be more relevant.
NCT01275898.
颅后神经外科手术通常需要患者采取坐姿。这可能会导致心输出量降低和脑灌注不足，并且可能导致脑氧合不足。在本研究中，测量了坐姿神经外科手术期间的脑氧饱和度，并将其与心输出量相关联。
使用两种不同的监测仪 INVOS 和 FORE-SIGHT 连续测量围手术期脑氧饱和度。使用经食管超声心动图在八个预设时间点测量心输出量。
共纳入 40 例患者，但最终仅 35 例（20 例女性）采用坐姿进行手术。在第一个时间点，INVOS 测量的局部脑氧饱和度为 70（标准差 9）%；此后，每分钟增加 0.0187%（P<0.01）。FORE-SIGHT 测量的脑氧饱和度从 68（标准差 13）%开始，每分钟增加 0.0142%（P<0.01）。平均动脉压没有变化。心输出量在预设时间点为 6.3（标准差 1.3）至 7.2（1.8）升/分钟。心输出量，而不是平均动脉压，与脑氧饱和度呈正相关且有统计学意义。
在坐姿神经外科手术中，脑氧饱和度缓慢增加，因此，就脑氧饱和度而言，这种体位似乎是安全的。脑氧饱和度稳定，因为 CO 和 MAP 保持恒定，而 CO 对脑氧饱和度的影响似乎更为相关。
NCT01275898。
