Bové, Thierry

De Hert, Stefan

DEBLAERE, ISABEL

Francois, Katrien

Moerman, Anneliese

Wouters, Patrick

English

Ghent University Academic Bibliography

Effect of blood pressure management during aortic  coarctation repair on tissue oxygen saturation  measured by near-infrared spectroscopy  Annelies Moerman1, Thierry Bové2, Katrien François2, Isabel Deblaere1, Patrick Wouters1, Stefan De Hert1  Department of Anesthesiology1 and Department of Cardiac Surgery2, Ghent University Hospital, Gent, Belgium  Background  This study compares the effects of three commonly used blood pressure regulating agents on tissue oxygen saturation of the brain and peripheral tissues, during aortic coarctation repair in children, with the use of near-infrared spectroscopy. Based on the reported adverse effect of sodium nitroprusside (SNP) on tissue oxygen saturation, we wanted to explore the hypothesis that the alteration in tissue oxygen saturation occurring with SNP would not be present with sevoflurane and nitroglycerin (NTG).  Methods   • 30 children with isolated aortic coarctation were randomized to sevoflurane, SNP or NTG for blood pressure control during aortic cross-clamping.  • Bilateral regional cerebral oxygen saturation (rScO2), renal oxygen saturation (SrO2) and muscle oxygen saturation (SmO2) were continuously recorded (INVOS 5100, Somanetics Corporation, Troy, MI).  • Changes in tissue oxygen saturation, rate of decay and area under the curve (AUC) were compared between treatment groups. Relationships between changes in tissue oxygen saturation and changes in blood pressure were evaluated by correlation and linear regression analysis.   Results  • There were no significant differences between treatment groups for rScO2.  • Treatment with SNP resulted in a significantly larger and faster decrease of SrO2 and SmO2 compared to NTG (Table and Fig 1).  • Linear regression analysis showed a lower dependence between mean arterial pressure and rScO2 for NTG (Fig 2).  Conclusion  This study confirms the hypothesis that SNP promotes impaired peripheral tissue oxygenation.  Our data suggest that nitroglycerin might be preferable to sodium nitroprusside for blood pressure control  during procedures involving aortic cross-clamping.   Fig 1. Area under the curve (AUC) for tissue oxygen saturation during aortic cross-clamping, indicating a significantly larger decrease in renal and muscle saturation in the SNP group compared to the NTG group (* p<0.05 from NTG)  Fig 2. Linear regression plot showing lower dependence between right cerebral oxygen saturation and MAP in the NTG group Sevo group SNP    group  NTG   group p-value between groups Max change in SrO2 (%) -43  19 -59  13* -33  22 0.028 Max change in SmO2 (%) -55  19 -64  17* -34  25 0.014 Decay rate SrO2 (%/min) -5.6  3.1 -7.7  2.7* -3.9  3.0 0.034 Decay rate SmO2 (%/min) -6.2  2.4 -9.3  3.7* -3.9  2.7 0.003 * p<0.05 from NTG 

Effect of blood pressure management during aortic coarctation repair on tissue oxygen saturation measured by near-infrared spectroscopy

https://biblio.ugent.be/publication/2971985/file/2977867.pdf

Effect of blood pressure management during aortic coarctation repair on tissue oxygen saturation measured by near-infrared spectroscopy

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Ghent University Academic Bibliography