Features of noninvasive cerebral oximetry and central hemodynamics in young children with hydrocephalus

O.S.  Pavlysh; V.I.  Snisar

doi:10.26641/2307-0404.2021.3.242093

Автор(и)

O.S. Pavlysh Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Україна https://orcid.org/0000-0002-3391-4218
V.I. Snisar Dnipro State Medical University, V. Vernadsky str., 9, Dnipro, 49044, Україна https://orcid.org/0000-0002-1304-4665

DOI:

https://doi.org/10.26641/2307-0404.2021.3.242093

Ключові слова:

hydrocephalus, children, cerebral oximetry, hemodynamics, anesthesia

Анотація

Hydrocephalus is one of the most common diseases of the nervous system in young children. Features of structural and morphological changes of the brain in children with hydrocephalus are the predominance of signs of periventricular ischemia of brain tissue due to cerebral circulatory disorders. Despite the existence of a large number of methods for assessing cerebral hemodynamics, in the modern literature there is only limited information about the oxygen status of the brain when using different types of anesthesia in children. The aim of the study was to assess the dynamics of noninvasive cerebral oximetry and central hemodynamics in young children with hydrocephalus during ventriculoperitoneal shunting. The research included 59 young children with acquired hydrocephalus who underwent ventriculoperitoneal shunting. 34 children underwent total intravenous anesthesia with propofol, 25 children – total inhalation anesthesia with sevoflurane. Intraoperative control of vital functions of the patient was performed: systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, regional saturation, carbon dioxide level on exhalation, sevoflurane concentration on inspiration and exhalation, non-invasive cerebral indicators. Children with acquired hydrocephalus had cerebral oximetry within normal regional level. The use of sevoflurane leads to increased cerebral oxygenation by inhibiting cerebral metabolic needs for oxygen and vasodilation of blood vessels with increased cerebral blood flow. Total intravenous anesthesia does not change the rate of intraoperative cerebral oxygenation, leads to hemodynamic changes in the form of decreased stroke volume, which may indicate that propofol reduces the level of oxygen consumption by the brain with decreased cerebral blood flow against the background of hemodynamic inhibition.

Посилання

Antomonov M. [Mathematical processing and analysis of biomedical data]. 2nd ed. Kyiv: MIC «Medinform»; 2018. p. 579. ISBN 978-966-409-202-6. Russian.

Zabolotskikh IB., inventor. [Method for determining the stroke volume of the heart pat. 2186520 Russian Federation: IPC A61B5/029. No. 2000130456/14: Appl. 12/04/2000]. publ. 10.08.2002, Bul. No. 22. Russian.

Bahloul: Two-Element Fractional-Order Windkessel Model to Assess the Arterial Input Impedance. Annu Int Conf IEEE Eng Med Biol Soc. 2019 Jul;5018-23. doi: https://doi.org/10.1109/EMBC.2019.8857722

Baxter A , McCormack JG. Total intravenous anesthesia in neonates. Paediatr Anaesth. 2019;29(11):1081-2. doi: https://doi.org /10.1111/pan.13745.

Limbrick DJr, Baird LC, Klimo PJr, Riva-Cambrin J, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children. J Neurosurg Pediatr. 2014;14(1):30-4. doi: https://doi.org/10.3171/2014.7.PEDS14324

Drummond JC. Blood Pressure and the Brain: How Low Can You Go? Anesth Analg. 2019;128(4):759-71. doi: https://doi.org/10.1213/ANE.0000000000004034

Dewan MC, Rattani A, Mekary R, Glancz LG, Yunusa I, Baticulon RE, et al. Global hydrocephalus epi¬demiology and incidence: systematic review and meta-analysis. J Neurosurg. 2018;1:1-15. doi: https://doi.org/10.3171/2017.10.JNS17439

Chen S, Luo J, Reis C, et al. Hydrocephalus after Subarachnoid Hemorrhage: Patho¬physiology, Diagnosis, and Treatment. Biomed Res Int. 2017;2017:8584753. doi: https://doi.org/10.1155/2017/8584753

Yeom KW, Lober RM, Alexander A, Cheshier SH, Edwards MS. Hydrocephalus decreases arterial spin-labeled cerebral perfusion. AJNR Am J Neuroradiol. 2014;35(7):1433-9. doi: https://doi.org/10.3174/ajnr.A3891

Kennedy RR, Hendrickx JF, Feldman JM. There are no dragons: Low-flow anaesthesia with sevoflurane is safe. Аnaesth Intensive Care. 2019;47(3):223-5. doi: https://doi.org/10.1177/0310057X19843304

Mayhew D, Mendonca V, Murthy BV. A review of ASA physical status - historical perspectives and modern developments. Anaesthesia. 2019;74(3):373-9. doi: https://doi.org/10.1111/anae.14569

Palanca BA, Avidan MS, Mashour GA. Human neural correlates of sevoflurane-induced unconsciousness. Br J Anaesth. 2017;119(4):573-582. doi: https://doi.org/10.1093/bja/aex244

Checketts MR, Alladi R, Ferguson K, Gemmell L, Handy JM, Klein AA, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71(1):85-93. doi: https://doi.org/10.1111/anae.13316

Sood BG, McLaughlin K, Cortez J. Near-infrared spectroscopy: applications in neonates. Semin Fetal Neonatal Med. 2015;20(3):164-72. doi: https://doi.org/10.1016/j.siny.2015.03.008

Williams M, Lee JK. Intraoperative blood pressure and perfusion of the brain: strategies for clarifying hemodynamic goals. Paediatr Anaesth. 2014;24(7):657-67. doi: https://doi.org/10.1111/pan.12401