Non-invasive oximetry for early detection of cerebral and somatic ischaemia during corrective surgery for aortic coarctation in paediatric patients

Abstract

ischaemic and bleeding events, and to calculate the confidence limits of these event rates, as we have done. 1 Now, with 44 patients and still no ischaemic events, our 97.5% upper confidence level is 8.04%, which is far below the event rates published by the Cleveland and Dutch investigators. 11 12 This prospective observational approach makes sense only if the participating hospitals agree to enrol consecutive patients with the study enrolment characteristics. Several other hospitals in Italy are now using our protocol, and a formal enlarged study is being submitted to our Ethical Committee, in order to have a more solid estimate of the performance of this treatment strategy. Whether this approach is solid enough to generate recommendations depends on the Guideline writing committees: based on our growing experience in treating these patients, bridge therapy using a short-acting antiplatelet agent is effective.

Postoperative kidney oxygen saturation as a novel marker for acute kidney injury after adult cardiac surgery

“…10 However, there may be no significant changes in bSo 2 with significant decreases observed in kidney oxygen saturation (kSo 2 ) or other somatic rSo 2 during crossclamp. 11 The relationship between postoperative kSo 2 and AKI in adults undergoing cardiac surgery has not been determined, because most studies have only focused on intraoperative period monitoring, leaving the direct influence in the postoperative time span unknown.…”

Correlation Between Cerebral‐Renal Near‐Infrared Spectroscopy and Ipsilateral Renal Perfusion Parameters as Clinical Outcome Predictors After Open Heart Surgery in Neonates and Infants

“…Near infrared spectroscopy (NIRS) is a useful tool for estimation of cerebral and visceral oxygenation, which might serve as an early predictor of ischemia, morbidity, and mortality as well as shorter hospital and ICU stay (11,12). Parameters measured by RDUS (RI and PSV) may help to detect the early changes in renal perfusion and vascular resistance; however to the best of our knowledge, there is no published article emphasizing correlations among cerebral, renal NIRS values, and renal perfusion parameters that might be helpful in predicting the postoperative clinical outcomes in neonates and infants undergoing congenital heart surgery.…”

Anesthetic Management of Surgical Repair of Coarctation of Aorta in Neonates and Infants

“…Renal NIRS may be used for monitoring the lower body perfusion during application of aortic cross clamp, but it's not used as a guide for further management [21,22]. A urinary catheter must be inserted to monitor urine output.…”

“…Many drugs such as naloxone and steroids have been shown to reduce the risk of spinal cord injury in animal models, but these have not been studied during surgical repair of coarctation of aorta and are not routinely used [24]. Minimizing the aortic cross clamp time to less than (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) minutes is well tolerated with reduced risk of spinal cord ischemia [25].…”