Use of transcranial Doppler ultrasonography and jugular oximetry to optimize hemodynamics during pediatric posterior fossa craniotomy.
We describe a 13-year-old child who developed inadvertent intraoperative cerebral oxygen desaturation attributed to empiric hyperventilation during posterior fossa craniotomy, diagnosed by jugular venous oximetry. Although restoration of normocapnia at age-appropriate mean arterial blood pressure improved jugular venous saturation (SjvO), it remained below acceptable values. Transcranial-Doppler (TCD) ultrasonography-guided stepwise increase in mean arterial pressure led to a linear increase in the mean flow velocity of the middle cerebral artery and SjvO₂ to desirable values. Intraoperative SjvO₂ monitoring and TCD ultrasonography may be utilized together to individualize hemodynamic targets and ventilation parameters and maintain adequate cerebral oxygenation during paediatric craniotomies.
Sharma
Deepak
D
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA.
Ellenbogen
Richard G
RG
Vavilala
Monica S
MS
D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000098:blood supply; D003399:Craniotomy / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology*; D015192:Infratentorial Neoplasms / Q000601:surgery; D007601:Jugular Veins; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D009373:Neoplasms, Germ Cell and Embryonal / Q000601:surgery; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D017585:Ultrasonography, Doppler, Transcranial
D010100:Oxygen