title: Intraoperative trans-fontanellar cerebral ultrasonography in infants during cardiac surgery under cardiopulmonary bypass: an observational study.
abstract: This study was performed to evaluate the feasibility of intraoperative point-of-care trans-fontanellar cerebral ultrasonography (TFCU) to obtain blood flow velocity (BFV) reference values at the internal carotid arteries (ICAs) and peri-callosal part of the anterior cerebral artery (pACA) during pediatric cardiac surgery under cardiopulmonary bypass (CPB). TFCU was performed at three time points (after induction of anesthesia, during CPB, after CPB) in 35 infants. BFV was measured at both ICAs and pACA through the anterior fontanelle with an ultrasound sector probe. We divided patients into Group S (<5 kg, n = 16) and Group L (≥5 kg, n = 19) for comparisons according to weight. We also analyzed BFV in low cerebral regional oxygen saturation (rSO2) data. All measurements of the BFV at both the ICAs and the pACA were possible. BFVs at the ICAs were lower in Group S than in Group L at all three time points. BFVs at the pACA were similar in both groups except higher value in Group L after CPB. When the rSO2was <50, most BFVs (14 of 15 measurements) were lower than the median BFV value during CPB. However, a low rSO2did not always reflect low BFV before and after CPB. Point-of-care TFCU can determine BFV at the ICAs and pACA during pediatric cardiac surgery. BFV differs according to the patient's size and CPB application. TFCU can be a practical cerebral blood flow monitoring method when rSO2changes without any specific reason in infants.ClinicalTrials.gov NCT01996020.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, #102 Heuk-seok-ro, Dong-jak-gu, Seoul, 06973, Republic of Korea.
authors.forename: Yong-Hee
authors.initials: YH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
authors.forename: In-Kyung
authors.initials: IK
authors.lastname: Song
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
authors.forename: Hee-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
authors.forename: Chong-Sung
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, #101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea. jintae73@gmail.com.
authors.forename: Jin-Tae
authors.initials: JT
authors.lastname: Kim
mesh_terms: D000768:Anesthesia, General; D001783:Blood Flow Velocity; D001835:Body Weight; D001921:Brain / Q000000981:diagnostic imaging*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002343:Carotid Artery, Internal / Q000473:pathology; D002560:Cerebrovascular Circulation; D006801:Humans; D007223:Infant; D016343:Monitoring, Intraoperative / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D019095:Point-of-Care Systems; D012016:Reference Values; D019265:Spectroscopy, Near-Infrared; D014463:Ultrasonography / Q000379:methods*
chemical_list: D010100:Oxygen
keywords: Cerebral blood flow; Heart—cardiopulmonary bypass; Infants; Ultrasonography