J Clin Monit Comput - The influence of basic ventilation strategies on cerebral oxygenation in anesthetized patients without vascular disease.


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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 (FIO: (2)) or end-tidal carbon dioxide (PETCO: (2)) in anesthetized patients without vascular disease. Here we tested the hypothesis that changes in FIO: (2) or PETCO: (2) correlate to a significant change in regional cerebral oxygenation (rSO(2)) in anesthetized patients without vascular disease. Methods. This was a prospective pilot study approved by the IRB. We measured rSO(2) 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, FIO: (2) and minute ventilation were sequentially adjusted. At each set point, rSO(2) 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 rSO(2) resultant upon each intervention. Results. The baseline rSO(2) was measured with patients awake, breathing room air and varied between 48 and 72%. While maintaining PETCO: (2) in the range 30-35?mmHg, rSO(2) was 8% higher when 100% oxygen was delivered compared to FIO: (2) 30% (P?=?0.021). While maintaining PETCO: (2) in the range 40-45?mmHg, rSO(2) was 7% higher when 100% oxygen is delivered compared to FIO: (2) 30% (P?=?0.032). While maintaining FIO: (2) at 100%, rSO(2) was 2% higher when PETCO: (2) was in the range 40-45?mmHg compared to PETCO: (2) 30-35?mmHg (P?=?0.017). While maintaining FIO: (2) at 30%, rSO(2) was not statistically different between P(E)CO(2) 40-45?mmHg and PETCO: (2) 30-35?mmHg. Conclusions. Modulating oxygenation and ventilation in anesthetized patients without vascular disease leads to measurable changes in rSO(2).

Resumo Limpo

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