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Cerebral oximetry monitoring during sinus endoscopy
Author(s) -
Heller Joshua A.,
DeMaria Samuel,
Govindaraj Satish,
Lin HungMo,
Fischer Gregory W.,
Evans Adam,
Weiner Menachem M.
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25027
Subject(s) - medicine , anesthesia , pacu , interquartile range , pulse oximetry , postoperative nausea and vomiting , prospective cohort study , cerebral autoregulation , cerebral perfusion pressure , surgery , cerebral blood flow , nausea , blood pressure , autoregulation
Objectives/Hypothesis Deliberate hypotension, reverse Trendelenburg position, and hyperventilation are techniques utilized during functional endoscopic sinus surgery to attempt to reduce surgical bleeding. These methods may predispose patients to cerebral ischemia. Cerebral oximetry has not been investigated extensively within otolaryngologic surgery. Our study sought to address the question of whether cerebral oximetry is feasible in the FESS population and evaluate whether the data provided may be useful in the assessment of cerebral perfusion. Study Design Prospective, blinded, observational trial. Methods We designed a prospective, blinded, observational trial of patients undergoing functional endoscopic sinus surgery using cerebral oximetry monitoring. Collected data included mean arterial blood pressure (MAP), end‐tidal carbon dioxide (EtCO 2 ), cerebral saturation (SctO 2 ), postanesthesia care unit (PACU) length of stay, and incidence of postoperative nausea and vomiting (PONV). Results Thirty‐one subjects were enrolled into the study. Univariate analyses showed cross‐correlation between concurrent EtCO 2 values and SctO 2 of 0.43 (95% CI: 0.27 to 0.59) and between present EtCO 2 and the SctO 2 5 minutes later of 0.46 (95% CI: 0.33 to 0.59). MAP was not significantly cross‐correlated with SctO 2 . Patients who had an SctO 2 below 60% at any time had a median (interquartile range [IQR]) PACU length of stay of 167 (IQR, 95–386) minutes. Patients whose cerebral saturation did not fall below 60% at any time had a median PACU length of stay of 103 (IQR, 76–155) minutes. This difference did not reach statistical significance ( P = .257). The median (IQR) maximum decline in SctO 2 for patients with PONV was 11.2% (IQR, 8.2%–13.1%) and for patients without PONV was 7.1% (IQR, 5.1%–9.8%) ( P = .126). Conclusions Cerebral oximetry monitoring was feasible during functional endoscopic sinus surgery. This study demonstrated a cross‐correlation between EtCO 2 and SctO 2 , but not MAP and SctO 2 . A longer PACU length of stay and higher rate of PONV were seen but did not reach statistical significance. Level of Evidence 2b Laryngoscope , 125:E127–E131, 2015