Changes in cerebral oxygen saturation during trans

Authors: Jessica Brodt Greta Vladinov Catalina CastilloPedraza Lebron Cooper Edward Maratea

Publish Date: 2016/03/11

Volume: 30, Issue: 5, Pages: 649-653

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Abstract

Cerebral oxygen saturation rSO2 is a noninvasive monitor used to monitor cerebral oxygen balance and perfusion Decreases in rSO2 20  from baseline have been associated with cerebral ischemia and increased perioperative morbidity During transcatheter aortic valve replacement TAVR hemodynamic manipulation with ventricular pacing up to 180 beats per minute is necessary for valve deployment The magnitude and duration of rSO2 change during this manipulation is unclear In this small case series changes in rSO2 in patients undergoing TAVR are investigated Ten ASA IV patients undergoing TAVR with general anesthesia at a university hospital were prospectively observed Cerebral oximetry values were analyzed at four points preprocedure baseline after tracheal intubation during valve deployment and at procedure end Baseline rSO2 values were 545 ± 69  After induction of general anesthesia rSO2 increased to a mean of 660 ± 67  During valve deployment the mean rSO2 decreased 20  below baseline to 485 ± 134  In two patients rSO2 decreased 20  of baseline Cerebral oxygenation returned to postinduction values in all patients 13 ± 10 min after valve deployment At procedure end the mean rSO2 was 676 ± 81  As expected rapid ventricular pacing resulting in the desired decrease in cardiac output during valve deployment was associated with a significant decrease in rSO2 compared to postinduction values However despite increased postinduction values in all patients whether related to increased inspired oxygen fraction or reduced cerebral oxygen consumption under anesthesia two patients experienced a significant decrease in rSO2 compared to baseline Recovery to baseline was not immediate and took up to 20 min in three patients Furthermore baseline rSO2 in this population was at the lower limit of the published normal range Significant cerebral desaturation during valve deployment may potentially be limited by maximizing rSO2 after anesthetic induction Future studies should attempt to correlate recovery in rSO2 with recovery of hemodynamics and cardiac function provide detailed neurological assessments pre and post procedure determine the most effective method of maximizing rSO2 prior to hemodynamic manipulation and provide the most rapid method of recovery of rSO2 following valve deployment

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