Journal of Anesthesia

, Volume 33, Issue 6, pp 701–703 | Cite as

Cerebral regional oxygen saturation: a useful monitor during a surgical procedure involving the right-sided aortic arch in an infant

  • Tomonori MoritaEmail author
  • Hiroaki Kishikawa
  • Atsuhiro Sakamoto
Clinical Report


A right aortic arch with an aberrant left subclavian artery and a Kommerell’s diverticulum represents a rare anatomic variant carrying the risk of dissection or rupture. Resection of the diverticulum and re-implantation of the left subclavian artery during childhood have been recommended. Because of the risk of cerebral blood flow reduction during the aberrant subclavian artery re-implantation to the common carotid artery, monitoring and prompt measures to curb blood flow reduction are required. A 5-month-old boy was scheduled to undergo resection surgery. During the translocation of the aberrant subclavian artery to the common carotid artery, his regional oxygen saturation (rSO2) in the left cerebrum began to decrease. We increased the end-tidal CO2 (EtCO2), mean arterial pressure, and a fraction of inspired oxygen, successfully restoring the rSO2 to the initial level. No postoperative neurological complications were observed. Our experience with this patient suggests that rSO2 monitoring is a useful, and intervention protocol including hypercapnia, elevated mean arterial pressure, and hyperoxia to counter the decreased cerebral blood flow is effective in infant patients undergoing right-sided aortic arch surgery.


Cerebral regional oxygen saturation Kommerell’s diverticulum Anesthesia 



  1. 1.
    Luciano D, Mitchell J, Fraisse A, Lepidi H, Kreitmann B, Ovaert C. Kommerell diverticulum should be removed in children with vascular ring and aberrant left subclavian artery. Ann Thorac Surg. 2015;100:2293–7.CrossRefGoogle Scholar
  2. 2.
    Bhandary SP, Papadimos TJ, Svensson LG, Sale S. Anesthetic management of the resection of a Kommerell’s diverticulum. J Cardiothorac Vasc Anesth. 2015;29:142–5.CrossRefGoogle Scholar
  3. 3.
    Samas J, Manetta F, Meyer DB. Repair of vascular ring with resection of Kommerell diverticulum and transposition of aberrant left subclavian artery. Int J Angiol. 2013;22:243–4.CrossRefGoogle Scholar
  4. 4.
    Zelijko C, Marko B, Anamarija B, Visnja I, Bojan B, Visnja M. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. Eur J Cardiothorac Surg. 2015;47:447–54.CrossRefGoogle Scholar
  5. 5.
    Zogogiannis ID, Iatrou CA, Lazarides MK, Vogiatzaki TD, Wachtel MS, Chatzigakis PK, Dimitriou VK. Evaluation of an intraoperative algorithm based on near-infrared refracted spectroscopy monitoring, in the intraoperative decision for shunt placement, in patients undergoing carotid endarterectomy. Middle East J Anaesthesiol. 2011;21:367–73.PubMedGoogle Scholar
  6. 6.
    Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, Cleland A, Schaefer B, Irwin B, Fox S. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007;104:51–8.CrossRefGoogle Scholar
  7. 7.
    Austin EH III, Edmonds HL Jr, Auden SM, Seremet V, Niznik G, Sehic A, Sowell MK, Cheppo CD, Corlett KM. Benefit of neurophysiologic monitoring for pediatric cardiac surgery. J Thorac Cardiovasc Surg. 1997;114:707–15 (discussion 715–6).CrossRefGoogle Scholar
  8. 8.
    Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM 3rd, Rodriguez AL, Magovern CJ, Zaubler T, Freundlich K, Parr GV. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009;87:36–44.CrossRefGoogle Scholar
  9. 9.
    Yao FS, Tseng CC, Ho CY, Levin SK, Illner P. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18:552–8.CrossRefGoogle Scholar
  10. 10.
    Edmonds HL Jr. Multi-modality neurophysiologic monitoring for cardiac surgery. Heart Surg Forum. 2002;5:225–8.PubMedGoogle Scholar
  11. 11.
    Stoneham MD, Lodi O, de Beer TC, Sear JW. Increased oxygen administration improves cerebral oxygenation in patients undergoing awake carotid surgery. Anesth Analg. 2008;107:1670–5.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyNippon Medical SchoolTokyoJapan
  2. 2.TokyoJapan

Personalised recommendations