Journal of Clinical Monitoring and Computing

, Volume 24, Issue 6, pp 421–425 | Cite as

The influence of basic ventilation strategies on cerebral oxygenation in anesthetized patients without vascular disease

  • Paul Picton
  • Amy Shanks
  • Perma Dorje
  • George A. Mashour
Article

Abstract

Objectives. Optimizing cerebral oxygenation is of paramount importance in certain intraoperative situations. There is, however, a paucity of published data pertaining to changes in cerebral oxygenation seen with increases in the inspired fraction of oxygen (Fio2) or end-tidal carbon dioxide (Petco2) in anesthetized patients without vascular disease. Here we tested the hypothesis that changes in Fio2 or Petco2 correlate to a significant change in regional cerebral oxygenation (rSO2) in anesthetized patients without vascular disease. Methods. This was a prospective pilot study approved by the IRB. We measured rSO2 using the INVOS 5100B monitor in ten anesthetized patients. Patients were excluded if they had a history of or risk factors for vascular disease, suffered from respiratory failure, or did not speak English. Following induction of anesthesia and intubation, Fio2 and minute ventilation were sequentially adjusted. At each set point, rSO2 was recorded and arterial blood gas analysis was performed. Each patient acted as their own control. A paired-sample t test was used to evaluate the change in rSO2 resultant upon each intervention. Results. The baseline rSO2 was measured with patients awake, breathing room air and varied between 48 and 72%. While maintaining Petco2 in the range 30–35 mmHg, rSO2 was 8% higher when 100% oxygen was delivered compared to Fio2 30% (P = 0.021). While maintaining Petco2 in the range 40–45 mmHg, rSO2 was 7% higher when 100% oxygen is delivered compared to Fio2 30% (P = 0.032). While maintaining Fio2 at 100%, rSO2 was 2% higher when Petco2 was in the range 40–45 mmHg compared to Petco2 30–35 mmHg (P = 0.017). While maintaining Fio2 at 30%, rSO2 was not statistically different between PECO2 40–45 mmHg and Petco2 30–35 mmHg. Conclusions. Modulating oxygenation and ventilation in anesthetized patients without vascular disease leads to measurable changes in rSO2.

Keywords

regional cerebral oxygenation inspired oxygen end tidal carbon dioxide 

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Notes

Acknowledgments

The INVOS 5100B cerebral oxygenation monitor and cerebral oxygenation optodes were provided at no cost by the manufacturer (Somanetics Corporation, Troy, MI).

The authors have no conflict of interest.

References

  1. 1.
    Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103:i3–13.CrossRefPubMedGoogle Scholar
  2. 2.
    Fischer GW, Torrillo TM, Weiner MM, Rosenblatt MA. The use of cerebral oximetry as a monitor of the adequacy of cerebral perfusion in a patient undergoing shoulder surgery in the beach chair position. Pain Pract. 2009;9:304–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Casati A, Spreafico E, Putzu M, Fanelli G. New technology for noninvasive brain monitoring: continuous cerebral oximetry. Minerva Anestesiol. 2006;72:605–25.PubMedGoogle Scholar
  4. 4.
    Tisdall MM, Taylor C, Tachtsidis I, Leung TS, Elwell CE, Smith M. The effect on cerebral tissue oxygenation index of changes in the concentrations of inspired oxygen and end-tidal carbon dioxide in healthy adult volunteers. Anesth Analg. 2009;109:906–13.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Picton P, Chambers J, Shanks A, Dorje P. The influence of inspired oxygen fraction and end-tidal carbon dioxide on post-cross-clamp cerebral oxygenation during carotid endarterectomy under general anesthesia. Anesth Analg. 2010;110:581–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, Vaughn J, Nisman M. Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions. Anesth Analg. 2010;111:496–505.CrossRefPubMedGoogle Scholar
  8. 8.
    Samra SK, Dy EA, Welch K, Dorje P, Zelenock GB, Stanley JC. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology. 2000;93:964–70.CrossRefPubMedGoogle Scholar
  9. 9.
    Beese U, Langer H, Lang W, Dinkel M. Comparison of near-infrared spectroscopy and somatosensory evoked potentials for the detection of cerebral ischemia during carotid endarterectomy. Stroke. 1998;29:2032–7.PubMedGoogle Scholar
  10. 10.
    Kaminogo M, Ochi M, Onizuka M, Takahata H, Shibata S. An additional monitoring of regional cerebral oxygen saturation to HMPAO SPECT study during balloon test occlusion. Stroke. 1999;30:407–13.PubMedGoogle Scholar
  11. 11.
    Cho H, Nemoto EM, Yonas H, Balzer J, Sclabassi RJ. Cerebral monitoring by means of oximetry and somatosensory evoked potentials during carotid endarterectomy. J Neurosurg. 1998;89:533–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Cuadra SA, Zwerling JS, Feuerman M, Gasparis AP, Hines GL. Cerebral oximetry monitoring during carotid endarterectomy: effect of carotid clamping and shunting. Vasc Endovascular Surg. 2003;37:407–13.CrossRefPubMedGoogle Scholar
  13. 13.
    Harris DN, Bailey SM. Near infrared spectroscopy in adults. Does the INVOS 3100 really measure intracerebral oxygenation? Anaesthesia. 1993;48:694–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Fearn SJ, Mead GE, Picton AJ, McCollum CN, Mortimer AJ. Cerebral oximetry in patients undergoing carotid endarterectomy under regional anesthesia. Stroke. 1996;27:1436–7.PubMedGoogle Scholar
  15. 15.
    Kishi K, Kawaguchi M, Yoshitani K, Nagahata T, Furuya H. Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers. J Neurosurg Anesthesiol. 2003;15:302–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Lovell AT, Marshall AC, Elwell CE, Smith M, Goldstone JC. Changes in cerebral blood volume with changes in position in awake and anesthetized subjects. Anesth Analg. 2000;90:372–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Stoneham MD, Martin T. Increased oxygen administration during awake carotid surgery can reverse neurological deficit following carotid cross-clamping. Br J Anaesth. 2005;94:582–5.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Paul Picton
    • 1
  • Amy Shanks
    • 1
  • Perma Dorje
    • 1
  • George A. Mashour
    • 1
  1. 1.Department of AnesthesiologyUniversity of Michigan Medical SchoolAnn ArborUSA

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