Froyshteter Alexander B, Tumin Dmitry, Whitaker Emmett E, Martin David P, Hakim Mumin, Walia Hina, Bhalla Tarun, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA.
J Anesth. 2018 Apr;32(2):288-292. doi: 10.1007/s00540-017-2446-8. Epub 2018 Jan 12.
Use of spinal anesthesia (SA) in children may address concerns about potential neurocognitive effects of general anesthesia. We used near-infrared spectroscopy (NIRS) to assess the effects of SA on cerebral and tissue oxygenation in 19 patients aged 7 ± 3 months. Prior to SA placement, NIRS monitors were placed on the forehead (cerebral) and the thigh (tissue). Intraoperative cerebral and tissue saturation were 73 ± 7 and 80 ± 11%, respectively, before SA placement. NIRS measurements were monitored every minute for 30 min after SA placement and modeled using mixed-effects linear regression. Regression estimates showed that cerebral saturation remained stable from 67% [95% confidence interval (CI) 63, 71%] after SA placement to 68% (95% CI 65, 72%) at the conclusion of monitoring. After SA placement, tissue saturation was elevated compared to baseline values; but further change [from 91% (95% CI 89, 93%) to 93% (95% CI 91, 95%) at the end of monitoring] was clinically non-significant. All patients breathed spontaneously on room air without changes in oxygen saturation. Blood pressure and heart rate decreased after SA placement, but no changes in hemodynamic parameters required treatment. These data provide further evidence of the neutral effect of SA on cerebral oxygenation 30 min after block placement.
在儿童中使用脊髓麻醉（SA）可能会消除对全身麻醉潜在神经认知影响的担忧。我们使用近红外光谱（NIRS）评估了19名年龄为7±3个月的患者中SA对脑和组织氧合的影响。在放置SA之前，将NIRS监测仪放置在前额（脑部）和大腿（组织）上。放置SA前，术中脑饱和度和组织饱和度分别为73±7%和80±11%。放置SA后每分钟监测NIRS测量值30分钟，并使用混合效应线性回归进行建模。回归估计显示，放置SA后脑饱和度从67%[95%置信区间（CI）63，71%]保持稳定，至监测结束时为68%（95%CI 65，72%）。放置SA后，组织饱和度相对于基线值升高；但进一步的变化[从监测结束时的91%（95%CI 89，93%）至93%（95%CI 91，95%）]在临床上无显著意义。所有患者在室内空气中自主呼吸，氧饱和度无变化。放置SA后血压和心率下降，但血流动力学参数的变化无需治疗。这些数据为放置阻滞30分钟后SA对脑氧合的中性作用提供了进一步证据。
