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

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Abstract

Introduction

Near-infrared spectroscopy (NIRS) was used to monitor intraoperative regional oxygen saturation (rSO2) 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 rSO2 (C-rSO2) and renal rSO2 (R-rSO2), 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 rSO2.

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-rSO2): N = 14/35 (40.0%) versus MOp = 3/36 (8.3%) and MMI = 7/58 (12.1%); p = 0.0006, and PD(R-rSO2): N = 27/35 (77.1%) versus MOp = 6/36 (16.7%) and MMI = 7/58 (12.1%); p < 0.0001, respectively. PD(R-rSO2) occurred immediately with visceral reduction in NOp (Fig. 1) and PD was frequent during NMI(Th) (Fig. 2). rSO2 was stable throughout MOp and MMI (Fig. 3).

Pathological desaturation in renal rSO2 after visceral reduction for gastroschisis. Renal rSO2 deteriorated immediately after viscera were returned to the abdominal cavity rSO2 regional oxygen saturation

Fragility of tissue perfusion during thoracoscopic lung lobectomy in a neonate. Pathological desaturation occurred frequently during neonatal thoracoscopic surgery rSO2 regional oxygen saturation

Changes in cerebral and renal rSO2 according to operative time. Cerebral and renal rSO2 did not appear to change according to operative time during major open and major minimally invasive surgery in children. rSO2 regional oxygen saturation

Conclusions

NIRS is a non-invasive technique for monitoring rSO2 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.

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Authors and Affiliations

  1. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2–1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan

    Yuichiro Miyake, Shogo Seo, Takanori Ochi, Go Miyano, Hiroyuki Koga, Geoffrey J. Lane & Atsuyuki Yamataka

  2. Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2–1-1 Hongo Bunkyo-ku Tokyo, Tokyo, 113-8421, Japan

    Kumi Kataoka, Kinya Nishimura & Eiichi Inada

Authors
  1. Yuichiro Miyake
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  2. Shogo Seo
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  3. Kumi Kataoka
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  4. Takanori Ochi
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  5. Go Miyano
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  6. Hiroyuki Koga
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  7. Geoffrey J. Lane
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  8. Kinya Nishimura
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  10. Atsuyuki Yamataka
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Correspondence to Yuichiro Miyake.

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Miyake, Y., Seo, S., Kataoka, K. et al. Significant neonatal intraoperative cerebral and renal oxygen desaturation identified with near-infrared spectroscopy. Pediatr Surg Int 38, 737–742 (2022). https://doi.org/10.1007/s00383-022-05102-5

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