Cerebral oxygenation assessed by near-infrared spectroscopy in the sitting and prone positions during posterior fossa surgery: a prospective, randomized clinical study
Oxigenação cerebral avaliada por espectroscopia de infravermelho próximo nas posições sentada e prona durante cirurgia da fossa posterior: um estudo clínico prospectivo randomizado
Ozlem Korkmaz Dilmen, Eren Fatma Akcil, Hayriye Vehid, Yusuf Tunali
Abstract
Objectives
The sitting position (SP) or prone position (PP) are used for posterior fossa surgery. The SP induced reduction in cerebral blood flow and cerebral oxygen saturation (rSO2) has been shown in shoulder surgeries, but there is not enough data in intracranial tumor surgery. Studies showed that PP is safe in terms of cerebral oxygen saturation in patients undergoing spinal surgery. Our hypothesis is that the SP may improve cerebral oxygenation in the patients with intracranial pathologies, due to reduction in intracranial pressure. Therefore, we compared the effects of the SP and PP on rSO2 in patients undergoing posterior fossa tumor surgery.
Methods
Data were collected patients undergoing posterior fossa surgery, 20 patients in SP compared to 21 patients in PP. The rSO2 was assessed using INVOS monitor. Heart rate (HR), mean arterial pressure (MAP), EtCO2, BIS, and bilateral rSO2 were recorded preoperatively, and at 5, 8 and 11 minutes after the intubation and every 3 minutes after patient positioning until the initial surgical incision.
Results
Cerebral oxygenation slowly reduced in both the sitting and prone position patients following the positioning (p < 0.002), without any difference between the groups. The HR and MAP were lower in the sitting SP after positioning compared to the PP.
Conclusion
Neurosurgery in the SP and PP is associated with slight reduction in cerebral oxygenation. We speculate that if we rise the lower limit of MAP, we might have showed the beneficial effect of the SP on rSO2.
Keywords
Resumo
Introdução
A posição sentada (PS) ou a posição prona (PP) são utilizadas para cirurgia da fossa posterior. A redução induzida pela SP no fluxo sanguíneo cerebral e na saturação cerebral de oxigênio (rSO2) foi demonstrada em cirurgias de ombro, mas não há dados suficientes em cirurgia de tumor intracraniano. Estudos mostraram que a PP é segura em termos de saturação cerebral de oxigênio em pacientes submetidos a cirurgia de coluna. Nossa hipótese é que a OS pode melhorar a oxigenação cerebral nos pacientes com patologias intracranianas devido à redução da pressão intracraniana. Portanto, comparamos os efeitos da PS e da PP sobre o rSO2 em pacientes submetidos à cirurgia de tumor de fossa posterior.
Métodos
Os dados foram coletados de pacientes submetidos à cirurgia de fossa posterior, 20 pacientes em SP comparados a 21 pacientes em PP. O rSO2 foi avaliado utilizando o monitor INVOS. Frequência cardíaca (FC), pressão arterial média (PAM), EtCO2, BIS e rSO2 bilateral foram registrados no pré-operatório e aos 5, 8 e 11 minutos após a intubação e a cada 3 minutos após o posicionamento do paciente até a incisão cirúrgica inicial.
Resultados
A oxigenação cerebral reduziu lentamente tanto nos pacientes sentados quanto em decúbito ventral após o posicionamento (p < 0,002), sem diferença entre os grupos. A FC e a PAM foram menores na PS após posicionamento em comparação à PP.
Conclusão
A neurocirurgia na PS e PP está associada a ligeira redução na oxigenação cerebral. Especulamos que se aumentarmos o limite inferior da PAM, poderíamos ter mostrado o efeito benéfico do SP no rSO2.
Palavras-chave
References
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