Universität zu Köln

Nissen, Matthias ORCID: 0000-0001-5458-8127, Cernaianu, Grigore, Thraenhardt, Rene, Vahdad, Mohammad R., Barenberg, Karin and Troebs, Ralf-Bodo (2017). Does metabolic alkalosis influence cerebral oxygenation in infantile hypertrophic pyloric stenosis? J. Surg. Res., 212. S. 229 - 238. SAN DIEGO: ACADEMIC PRESS INC ELSEVIER SCIENCE. ISSN 1095-8673

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Abstract

Background: This pilot study focuses on regional tissue oxygenation (rSO(2)) in patients with infantile hypertrophic pyloric stenosis in a perioperative setting. To investigate the influence of enhanced metabolic alkalosis (MA) on cerebral (c-rSO(2)) and renal (r-rSO(2)) tissue oxygenation, two-site near-infrared spectroscopy (NIRS) technology was applied. Materials and methods: Perioperative c-rSO(2), r-rSO(2), capillary blood gases, and electrolytes from 12 infants were retrospectively compared before and after correction of MA at admission (T1), before surgery (T2), and after surgery (T3). Results: Correction of MA was associated with an alteration of cerebral oxygenation without affecting renal oxygenation. When compared to T1, 5-min mean (+/- standard deviation) c-rSO2 increased after correction of MA at T2 (72.74 +/- 4.60% versus 77.89 +/- 5.84%; P = 0.058), reaching significance at T3 (80.79 +/- 5.29%; P = 0.003). Furthermore, relative 30-min c-rSO2 values at first 3 h of metabolic compensation were significantly lowered compared with postsurgical states at 16 and 24 h. Cerebral oxygenation was positively correlated with levels of sodium (r = 0.37; P = 0.03) and inversely correlated with levels of bicarbonate (r = -0.34; P = 0.05) and base excess (r = -0.36; P = 0.04). Analysis of preoperative and postoperative cerebral and renal hypoxic burden yielded no differences. However, a negative correlation (r = -0.40; P = 0.03) regarding hematocrite and mean r-rSO(2), indirectly indicative of an increased renal blood flow under hemodilution, was obtained. Conclusions: NIRS seems suitable for the detection of a transiently impaired cerebral oxygenation under state of pronounced MA in infants with infantile hypertrophic pyloric stenosis. Correction of MA led to normalization of c-rSO(2). NIRS technology constitutes a promising tool for optimizing perioperative management, especially in the context of a possible diminished neurodevelopmental outcome after pyloromyotomy. (C) 2017 Elsevier Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Nissen, Matthias UNSPECIFIED orcid.org/0000-0001-5458-8127 UNSPECIFIED Cernaianu, Grigore UNSPECIFIED UNSPECIFIED UNSPECIFIED Thraenhardt, Rene UNSPECIFIED UNSPECIFIED UNSPECIFIED Vahdad, Mohammad R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Barenberg, Karin UNSPECIFIED UNSPECIFIED UNSPECIFIED Troebs, Ralf-Bodo UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-231096
DOI:	10.1016/j.jss.2017.01.019
Journal or Publication Title:	J. Surg. Res.
Volume:	212
Page Range:	S. 229 - 238
Date:	2017
Publisher:	ACADEMIC PRESS INC ELSEVIER SCIENCE
Place of Publication:	SAN DIEGO
ISSN:	1095-8673
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NEAR-INFRARED SPECTROSCOPY; BLOOD-FLOW; DISSOCIATION CURVE; SURGERY; CO2; PH; PNEUMOPERITONEUM; HYPOVENTILATION; HEMOGLOBIN; SATURATION Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/23109