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Effect of hyperextension of the neck (rose position) on cerebral blood oxygenation in patients who underwent cleft palate reconstructive surgery: prospective cohort study using near-infrared spectroscopy.
Clinical Oral Investigations ( IF 3.4 ) Pub Date : 2020-03-26 , DOI: 10.1007/s00784-019-03157-8
B J A Smarius 1 , C C Breugem 2, 3 , M P Boasson 4 , S Alikhil 4 , J van Norden 4 , A B Mink van der Molen 1 , J C de Graaff 4, 5
Affiliation  

Objectives

To facilitate the best approach during cleft palate surgery, children are positioned with hyperextension of the neck. Extensive head extension may induce intraoperative cerebral ischemia if collateral flow is insufficient. To evaluate and monitor the effect of cerebral blood flow on cerebral tissue oxygenation, near-infrared spectroscopy has proved to be a valuable method. The aim of this study was to evaluate and quantify whether hyperextension affects the cerebral tissue oxygenation in children during cleft palate surgery.

Materials and methods

This prospective study included children (ASA 1 and 2) under the age of 3 years old who underwent cleft palate repair at the Wilhelmina Children’s Hospital, in The Netherlands. Data were collected for date of birth, cleft type, date of cleft repair, and physiological parameters (MAP, saturation, heart rate, expiratory CO2 and O2, temperature, and cerebral blood oxygenation) during surgery. The cerebral blood oxygenation was measured with NIRS.

Results

Thirty-four children were included in this study. The majority of the population was male (61.8%, n = 21). The mixed model analyses showed a significant drop at time of Rose position of − 4.25 (69–74 95% CI; p < 0.001) and − 4.39 (69–74 95% CI; p < 0.001). Postoperatively, none of the children displayed any neurological disturbance.

Conclusion

This study suggests that hyperextension of the head during cleft palate surgery leads to a significant decrease in cerebral oxygenation. Severe cerebral desaturation events during surgery were uncommon and do not seem to be of clinical relevance in ASA 1 and 2 children.

Clinical relevance

There was a significant drop in cerebral oxygenation after positioning however it is not clear whether this drop is truly significant physiologically in ASA 1 and 2 patients.



中文翻译:

进行c裂重建手术的患者颈部过度伸展(玫瑰位置)对脑血氧的影响:使用近红外光谱的前瞻性队列研究。

目标

为了促进c裂手术中的最佳方法,将儿童放置在颈部过度伸直的位置。如果侧支流量不足,广泛的头部伸展可能会导致术中脑缺血。为了评估和监测脑血流对脑组织氧合的影响,近红外光谱已被证明是一种有价值的方法。这项研究的目的是评估和量化过度tension裂是否会影响hyper裂手术儿童的脑组织氧合。

材料和方法

这项前瞻性研究包括3岁以下的儿童(ASA 1和2),他们在荷兰的威廉敏娜儿童医院进行c裂修复。收集手术期间的出生日期,left裂类型,repair裂修复日期和生理参数(MAP,饱和度,心率,呼气性CO 2和O 2,温度和脑血氧合)的数据。用NIRS测量脑血氧含量。

结果

这项研究包括了34个孩子。人口的大多数是男性(61.8%,n  = 21)。混合模型分析显示,在罗斯位置时,显着下降了-4.25(69-74 95%CI; p  <0.001)和-4.39(69-74 95%CI; p  <0.001)。术后,所有儿童均未显示任何神经系统疾病。

结论

这项研究表明,left裂手术中头部的过度伸展会导致脑氧合的明显减少。在ASA 1和2儿童中,严重的脑去饱和事件在手术中并不常见,并且似乎与临床无关。

临床相关性

定位后脑氧合明显下降,但是尚不清楚这种下降在ASA 1和2患者中在生理上是否真正显着。

更新日期:2020-03-26
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