Significant neonatal intraoperative cerebral and renal oxygen desaturation identified with near-infrared spectroscopy.

INTRODUCTION

Near-infrared spectroscopy (NIRS) was used to monitor intraoperative regional oxygen saturation (rSO) during open (Op) and minimally invasive (MI) surgery performed in neonates (N) and children.

MATERIALS AND METHODS

NIRS sensors were applied to the forehead and flanks for cerebral rSO (C-rSO) and renal rSO (R-rSO), respectively. MI included laparoscopy (La), retroperitoneoscopy (Re) and thoracoscopy (Th). In children, Op and MI were major operations taking at least 3 h (MOp; MMI). Pathological desaturation (PD) was defined as > 20% deterioration in rSO.

RESULTS

Mean ages at surgery were N: 5.2 ± 8.2 days, MOp: 2.4 ± 2.9 years, and MMI: 3.8 ± 4.3 years. Despite significantly shorter operative times in N (169 ± 94 min; p < 0.0001), PD was significantly worse; PD(C-rSO): N = 14/35 (40.0%) versus MOp = 3/36 (8.3%) and MMI = 7/58 (12.1%); p = 0.0006, and PD(R-rSO): N = 27/35 (77.1%) versus MOp = 6/36 (16.7%) and MMI = 7/58 (12.1%); p < 0.0001, respectively. PD(R-rSO) occurred immediately with visceral reduction in NOp (Fig. 1) and PD was frequent during NMI(Th) (Fig. 2). rSO was stable throughout MOp and MMI (Fig. 3). Fig. 1 Pathological desaturation in renal rSO after visceral reduction for gastroschisis. Renal rSO deteriorated immediately after viscera were returned to the abdominal cavity rSO regional oxygen saturation Fig. 2 Fragility of tissue perfusion during thoracoscopic lung lobectomy in a neonate. Pathological desaturation occurred frequently during neonatal thoracoscopic surgery rSO regional oxygen saturation Fig. 3 Changes in cerebral and renal rSO according to operative time. Cerebral and renal rSO did not appear to change according to operative time during major open and major minimally invasive surgery in children. rSO regional oxygen saturation CONCLUSIONS: NIRS is a non-invasive technique for monitoring rSO as an indicator of intraoperative stress and vascular perfusion. PD was so significant in neonates that intraoperative NIRS is highly recommended during thoracoscopy and procedures requiring visceral manipulation.