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Clinical experience with intraoperative jugular venous oximetry during pediatric intracranial neurosurgery

Authors

  • Deepak Sharma,

    1. Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
    2. Department of Neurological Surgery, University of Washington, Seattle, WA, USA
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  • Arunotai Siriussawakul,

    1. Department of Anesthesiology, Mahidol University, Bangkok, Thailand
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  • Neil Dooney,

    1. Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
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  • James G. Hecker,

    1. Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
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  • Monica S. Vavilala

    Corresponding author
    1. Department of Neurological Surgery, University of Washington, Seattle, WA, USA
    2. Department of Pediatrics, University of Washington, Seattle, WA, USA
    3. Department of Radiology, University of Washington, Seattle, WA, USA
    • Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
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Correspondence

Monica S. Vavilala, Department of Anesthesiology & Pain Medicine, Harborview Medical Center, Box # 359724, 325, 9th Ave, Seattle, WA, USA

Email: vavilala@uw.edu

Summary

Aim

To report our institutional experience with intraoperative jugular venous oximetry during pediatric intracranial surgery to guide anesthetic care.

Background

The utility of intraoperative jugular venous oximetry in adults undergoing intracranial surgery is well known. However, there is a little information on its' application in children during intracranial surgery.

Methods

After IRB approval, we examined patient, equipment, placement, and sampling characteristics for jugular bulb catheters in children aged <18 years who were monitored with jugular oximetry during elective intracranial surgery between 2006 and 2010. We also determined the prevalence of intraoperative cerebral desaturation (SjvO2 < 55%), its causes, and the interventions based on jugular oximetry values.

Results

Data from 19 children (10 males and nine females), aged 12 ± 1 years (range 7–17) who underwent craniotomy for arteriovenous malformation (AVM) resection (68%), tumor removal (21%), or aneurysm clipping (11%), were reviewed. We analyzed 88 coincident SjvO2, PaCO2, and mean arterial pressure data points. Eleven (58%) patients experienced at least one episode of cerebral desaturation. There were 25 (28%) episodes of cerebral desaturation, six of which we attributed to relative hypotension, four to hypocarbia, and 15 to a combination of both. There were no intraoperative or immediate postoperative (first 24 h) complications because of jugular oximetry.

Conclusion

Findings from this series indicate that (i) intraoperative jugular venous oximetry in children is feasible in experienced hands, (ii) cerebral desaturation detected by jugular oximetry is common during pediatric intracranial procedures, and (iii) monitoring jugular venous saturation can impact anesthetic interventions to optimize cerebral physiology.

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