Significant neonatal intraoperative cerebral and renal oxygen desaturation identified with near-infrared spectroscopy

• Published in: Pediatric surgery international Vol. 38; no. 5; pp. 737 - 742
• Main Authors: Miyake, Yuichiro, Seo, Shogo, Kataoka, Kumi, Ochi, Takanori, Miyano, Go, Koga, Hiroyuki, Lane, Geoffrey J., Nishimura, Kinya, Inada, Eiichi, Yamataka, Atsuyuki
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2022; Springer Nature B.V
• Subjects: Abdomen; Abdominal Cavity; Brain - diagnostic imaging; Child; Congenital diseases; Cysts; Hernias; Humans; Infant, Newborn; Kidney - diagnostic imaging; Kidney - surgery; Laparoscopy; Medicine; Medicine & Public Health; Monitoring, Physiologic; Newborn babies; Original Article; Ostomy; Oximetry - methods; Oxygen; Oxygen saturation; Pediatric Surgery; Pediatrics; Physiology; Spectroscopy, Near-Infrared - methods; Spectrum analysis; Surgery; Surgical anastomosis; Regional oxygen saturation; Minimally invasive surgery; Neonate; Near-infrared spectroscopy
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-022-05102-5

Introduction
Near-infrared spectroscopy (NIRS) was used to monitor intraoperative regional oxygen saturation (rSO
2
) during open (Op) and minimally invasive (MI) surgery performed in neonates (N) and children.
Materials and methods
NIRS sensors were applied to the forehead and flanks for cerebral rSO
2
(C-rSO
2
) and renal rSO
2
(R-rSO
2
), respectively. MI included laparoscopy (La), retroperitoneoscopy (Re) and thoracoscopy (Th). In children, Op and MI were major operations taking at least 3 h (MOp; MMI). Pathological desaturation (PD) was defined as > 20% deterioration in rSO
2
.
Results
Mean ages at surgery were N: 5.2 ± 8.2 days, MOp: 2.4 ± 2.9 years, and MMI: 3.8 ± 4.3 years. Despite significantly shorter operative times in N (169 ± 94 min;
p
 < 0.0001), PD was significantly worse; PD(C-rSO
2
):
N
 = 14/35 (40.0%) versus MOp = 3/36 (8.3%) and MMI = 7/58 (12.1%);
p
 = 0.0006, and PD(R-rSO
2
): N = 27/35 (77.1%) versus MOp = 6/36 (16.7%) and MMI = 7/58 (12.1%);
p
 < 0.0001, respectively. PD(R-rSO
2
) occurred immediately with visceral reduction in NOp (Fig. 
1
) and PD was frequent during NMI(Th) (Fig. 
2
). rSO
2
was stable throughout MOp and MMI (Fig. 
3
).
Fig. 1
Pathological desaturation in renal rSO
2
after visceral reduction for gastroschisis. Renal rSO
2
deteriorated immediately after viscera were returned to the abdominal cavity
rSO
2
regional oxygen saturation
Fig. 2
Fragility of tissue perfusion during thoracoscopic lung lobectomy in a neonate. Pathological desaturation occurred frequently during neonatal thoracoscopic surgery
rSO
2
regional oxygen saturation
Fig. 3
Changes in cerebral and renal rSO
2
according to operative time. Cerebral and renal rSO
2
did not appear to change according to operative time during major open and major minimally invasive surgery in children
. rSO
2
regional oxygen saturation
Conclusions
NIRS is a non-invasive technique for monitoring rSO
2
as an indicator of intraoperative stress and vascular perfusion. PD was so significant in neonates that intraoperative NIRS is highly recommended during thoracoscopy and procedures requiring visceral manipulation.