Role of acute hypervolemic hemodilution with controlled hypotension and autologous blood transfusion on spinal surgery / 西安交通大学学报(医学版)

Objective To observe the clinical efficacy and safety of acute hypervolemic hemodilution (AHH) in combination with controlled hypotension (CH)and autologous blood transfusion (ABT)on spinal surgery. Methods For this study,we enrolled 50 patients undergoing spinal surgery and randomly divided them into two groups.The experimental group received AHH in combination with CH and ABT,while the control group received none of the above treatments.We compared the parameters such as hemodynamics,blood routine and coagulation, the amount of intraoperative bleeding,autologous and allogeneic blood transfusion volume,and regional cerebral oxygen saturation (rSO2)between the two groups.Results In the experimental group CVP increased,while invasive artery blood pressure, HCT, Hb, PLT and the amount of allogeneic blood transfusion decreased significantly compared with those of the control group (P＜0.05).As for the mean intraoperative blood loss, APTT,PT,TT,FIB and rSO2,there were no significant differences between the two groups (P＞0.05). Conclusion AHH in combination with CH and ABT can reduce the amount of allogeneic blood transfusion and has no adverse effect on hemodynamics,blood coagulation or cerebral oxygenation in spinal surgery patients.It is a safe and effective blood protection procedure during spinal surgery.

Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position / 대한마취과학회지

BACKGROUND: Cerebral hypotension and desaturation can occur during shoulder surgery in the seated position. We evaluated the correlation of cerebral oxygen saturation (rSO2) using near infra-red spectroscopy (NIRS) and mean arterial pressures (MAP) (at the levels of the brain and heart). METHODS: Fifty patients, scheduled for the arthroscopic shoulder surgery in the seated position, were enrolled to monitor the rSO2, bispectral Index (BIS), and MAPs at the levels of the brain and heart. The values of each parameter were collected at 5 min after intubation, immediately after placing the patient in the sitting position, 5 min after the patient was seated, immediately after the surgical incision, and every 30 min after incision. RESULTS: A correlation between the cerebral rSO2 and the MAP at the level of brain were statistically significant. Cerebral rSO2 and MAP after a change of posture from supine to sitting position were significantly decreased, compared to the baseline value. CONCLUSIONS: Monitoring cerebral rSO2 and MAP at the level of brain can be helpful to detect the possibility of cerebral deoxygenation earlier.

Anesthetic Management during Aortic Arch Surgery Using Anterograde Selective Cerebral Perfusion / 대한마취과학회지

Cerebral protection during aortic arch surgery is an anesthetic challenge, since the surgical procedures for aortic arch aneurysm involve an interruption of cerebral blood flow. We report a successfully managed case of aortic arch aneurysm repair with antegrade selective cerebral perfusion (SCP) during TCA (total circulatory arrest) using a transcranial oximeter, cerebral oxygenation was monitored during surgery. Although at the beginning of TCA a decrease in the regional cerebral oxygen saturation was observed, this was soon recovered by SCP. Except for the short period of TCA without SCP, regional cerebral oxygen saturation (rSO2) value were well maintained during surgery.

The comparison of cerebral oximetry and somatosensory evoked potential for monitoring carotid endarterectomy / 解放军医学杂志

Objective To compare cerebral oximetry(rSO 2 %)and somatosensory evoked potential (N 35 ) in their accuracy in monitoring cerebral perfusion during carotid endarterectomy procedure under general anesthesia. Methods Ten patients (6 males, 4 females), scheduled for selective carotid endarterectomy, were enrolled in the study. Their rSO 2 %and N 35 were also continuously monitored and recorded during perioperative periods. The patients' cognitive function was evaluated at the same time. The MAP, HR, SpO 2 were continuously monitored during operation. Results There was a significant difference in rSO 2 % between that at the period of elamping and that at the period of declamping of the carotid artery. No patients suffered from cognition dysfunction during perioperative period. Conclusion With comparison to the amplitude of N 35 it was rSO 2 % which was earlier to show alteration in cerebral perfusion in case of cerebral oxygen deficit. In monitoring cerebral perfusion, rSO 2 % was better than N 35