A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy

Westgarth-Taylor, Chris; Lijster, Leonnie de; Bogerijen, Guido van; Millar, Alastair J. W.; Karpelowsky, Jonathan

doi:10.1007/s00464-013-2950-3

Cited by 28 publications

(17 citation statements)

References 44 publications

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“…Little is known about the relevance of NIRS in the simultaneous monitoring of cerebral and abdominal or renal perfusion in neonatal digestive surgeries (13–16). Giliberti et al reported and summarized the results of a study on the application of NIRS in neonatal cardiac and digestive surgeries, on its future possibilities and its relevance on perfusion and oxygenation monitoring during these surgeries and during anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Monitoring Cerebral and Renal Oxygenation Status during Neonatal Digestive Surgeries Using Near Infrared Spectroscopy

Beck¹,

Loron²,

Masson

et al. 2017

Front. Pediatr.

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BackgroundDepending on the initial pathology, hypovolemia, intra-abdominal hypertension, and sepsis are often encountered in neonatal digestive surgery. Accurate newborn monitoring during and after surgery is essential to adapt resuscitation protocols. Near infrared spectroscopy (NIRS) is non-invasive and can detect hypoperfusion which indicates a low circulatory blood flow, regardless of the cause.ObjectiveEvaluating changes in cerebral and renal regional oxygen saturation during neonatal digestive surgeries, conducted according to normal practices, with commonly used monitoring parameters. Analyzing retrospectively the inter-relationships between NIRS values and mean arterial pressure (MAP) values as well as pre-ductal SpO2.MethodsProspective, descriptive, monocentric study. All neonates referred for surgery were included. NIRS allows the measurement of cerebral and renal oxygenation fluctuations, as well as calculating difference in intraoperative and postoperative values.ResultsNineteen patients were included. Cerebral regional oxygen saturation (C rSO2) values were stable while renal regional oxygen saturation (R rSO2) values tended to decrease with time during surgery. Indeed, 72% of rSO2 decline episodes occurred after the first 30 min of surgery, without any significant statistical differences for the next 90 min of surgery. After surgery, the lowest average C and R rSO2 values were evidenced during the first 6 h, with 60% of C rSO2 and R rSO2 anomalies occurring in that time frame. There was no significant statistical difference observed in the following 18 h. There was a significant correlation between R rSO2 and SpO2 values (p < 0.01), but not with C rSO2 values. There was no correlation with the MAP either for the C rSO2 values or R rSO2 ones.ConclusionNIRS is a promising non-invasive bedside tool to monitor cerebral and tissue perfusion, analyzing tissue microcirculation. NIRS has its interest to guide neonatal digestive surgeries (bowel manipulation, viscera reduction) and may represent an early warning for identifying patients requiring resuscitation during or after these surgeries.

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Section: Introductionmentioning

confidence: 99%

Monitoring Cerebral and Renal Oxygenation Status during Neonatal Digestive Surgeries Using Near Infrared Spectroscopy

Beck¹,

Loron²,

Masson

et al. 2017

Front. Pediatr.

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“…Although there are several studies assessing abdominal saturation with NIRS in various diseases, there are no studies evaluating this during CPR [9,11,[16][17][18][19]]. One animal model study performed to determine abdominal ischemia in patients with shock compared invasive techniques with NIRS and reported that NIRS was a good means of detecting abdominal ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Oxygenation of other organs is as important as that of the brain during CPR. Near-infrared spectrophotometry can assess myocardial, hepatic, and intestinal saturation by measuring tissue saturation [9][10][11]. Although cardiac activity can be evaluated with echocardiography, a noninvasive technique, invasive methods such as catheterization need to be used to assess abdominal oxygenation.…”

Section: Introductionmentioning

confidence: 99%

Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry

Kalkan¹,

Bilir²,

Ersunan³

et al. 2015

The American Journal of Emergency Medicine

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“…However, peritoneal gas insufflation during laparoscopy may lead to possibly harmful cardiovascular and respiratory alterations that could possibly be detrimental for the patient. [5678910131416] PP exerts its effects on organ systems primarily via physical pressure on those systems and secondly through the systemic absorption of CO 2 across the peritoneum and into the bloodstream.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair

et al. 2017

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BACKGROUND:The systemic impact of intra-abdominal pressure (IAP) and/or changes in carbon dioxide (CO2) during laparoscopy are not yet well defined. Changes in brain oxygenation have been reported as a possible cause of cerebral hypotension and perfusion. The side effects of anaesthesia could also be involved in these changes, especially in children. To date, no data have been reported on brain oxygenation during routine laparoscopy in paediatric patients.PATIENTS AND METHODS:Brain and peripheral oxygenation were investigated in 10 children (8 male, 2 female) who underwent elective minimally invasive surgery for inguinal hernia repair. Intraoperative transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation using pulse oximetry and heart rate (HR) were monitored at five surgical intervals: Induction of anaesthesia (baseline T1); before CO2 insufflation induced pneumoperitoneum (PP) (T2); CO2 PP insufflation (T3); cessation of CO2 PP (T4); before extubation (T5).RESULTS:rScO2 decreases were recorded immediately after T1 and became significant after insufflation (P = 0.006; rScO2 decreased 3.6 ± 0.38%); restoration of rScO2 was achieved after PP cessation (P = 0.007). The changes in rScO2 were primarily due to IAP increases (P = 0.06). The HR changes were correlated to PP pressure (P < 0.001) and CO2 flow rate (P = 0.001). No significant peripheral effects were noted.CONCLUSIONS:The increase in IAP is a critical determinant in cerebral oxygenation stability during laparoscopic procedures. However, the impact of anaesthesia on adaptive changes should not be underestimated. Close monitoring and close collaboration between the members of the multidisciplinary paediatric team are essential to guarantee the patient's safety during minimally invasive surgical procedures.

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A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy

Abstract: Renal hypoxia does not occur during laparoscopic surgery in children if the minimum age-appropriate intra-abdominal pressures are used. Alternative causes must account for the oliguria and anuria demonstrated in children undergoing laparoscopy.

Cited by 28 publications

References 44 publications

Monitoring Cerebral and Renal Oxygenation Status during Neonatal Digestive Surgeries Using Near Infrared Spectroscopy

Monitoring Cerebral and Renal Oxygenation Status during Neonatal Digestive Surgeries Using Near Infrared Spectroscopy

Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry

Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair

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