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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 CO 2  and O 2 , 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  &lt; 0.001) and − 4.39 (69–74 95% CI;  p  &lt; 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.

clinical oral investigations

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