High-quality evidence indicates that active cerebral oximetry monitoring during surgery improves patient outcomes in populations at risk for hemodynamic instability. This project piloted the use of a near-infrared spectroscopy (NIRS) monitor in a pediatric surgical population with similar risk factors. Controlled hypotension is an anesthetic technique used to minimize blood loss during pediatric spinal surgery for scoliosis correction. Consensus for safe blood pressure thresholds does not exist, and cerebral oxygenation may be impeded during this anesthetic technique.
Fifteen pediatric patients scheduled for posterior spinal fusion and scoliosis correction received intraoperative NIRS monitoring. Regional cerebral oxygen saturation (rSO2) and blood pressure data were collected. Possible relationships between mean arterial pressure and rSO2 were also explored. Anesthesia provider feedback regarding device use was obtained via a voluntary survey.
Twenty-four cerebral desaturation events (CDEs) were recorded among four patients (27%) involved in the project. The median CDE duration, nadir rSO2, and percent change from baseline was 3.38 minutes, 69%, and 22.5%, respectively (Interquartile ranges = 8.69, 22, and 22.99). There was no relationship between mean cerebral rSO2 and mean arterial pressure (rs(25) = −0.194, p = .353).
The results support the continued use of NIRS monitoring during pediatric scoliosis surgery. Analysis of individual CDEs reveals that some patients may incur more prolonged and significant CDEs. In addition, cerebral desaturations are difficult to predict using solely blood pressure parameters. Device ease of use, availability, and a high perception of clinical utility among anesthesia providers support adoption of the monitor in this setting.
Kaela Mukuno, DNP, CRNA Alumna, Duke University School of Nursing, Durham, NC.
Charles Vacchiano, PhD, CRNA, FAAN Professor, Duke University School of Nursing, Durham, NC.
Emily Funk, DNP, CRNA Clinical Associate, Duke University School of Nursing, Durham, NC; and Staff Nurse Anesthetist, Duke University Hospital, Durham, NC.
Brett Morgan, DNP, CRNA Assistant Professor, Duke University School of Nursing, Durham, NC.
The authors have declared no conflict of interest.
Correspondence: Kaela Mukuno, DNP, CRNA. E-mail: firstname.lastname@example.org