Cerebral oximetry monitoring during sinus endoscopy

Joshua A. Heller, Samuel Demaria, Satish Govindaraj, Hung Mo Lin, Gregory W. Fischer, Adam Evans, Menachem M. Weiner

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

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 (EtCO2), cerebral saturation (SctO2), 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 EtCO2 values and SctO2 of 0.43 (95% CI: 0.27 to 0.59) and between present EtCO2 and the SctO2 5 minutes later of 0.46 (95% CI: 0.33 to 0.59). MAP was not significantly cross-correlated with SctO2. Patients who had an SctO2 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 SctO2 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 EtCO2 and SctO2, but not MAP and SctO2. A longer PACU length of stay and higher rate of PONV were seen but did not reach statistical significance.

Original languageEnglish
Pages (from-to)E127-E131
JournalLaryngoscope
Volume125
Issue number4
DOIs
StatePublished - 1 Apr 2015

Keywords

  • Brain ischemia
  • hypotension
  • length of stay
  • paranasal sinuses
  • postoperative nausea
  • vomiting

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