Dynamic Changes in Left and Right Cerebral Oxygen Saturation during Selective Cerebral Perfusion in Young Infants

Abstract

Objectives We investigated whether the selective cerebral perfusion (SCP) technique causes differences in changes in cerebral perfusion between both hemispheres in young infants, using cerebral oxygen saturation (ScO2) as an index. Further, we determined the association between the discrepancy in ScO2 and cerebral perfusion pressure during SCP. Methods The difference in ScO2 between the left and right cerebral hemispheres (ΔScO2 Rt-Lt) was calculated during clamping of the innominate artery (IA) and during SCP. Results In 25 infants (aged 2 to 78 days), the left and right ScO2 were well maintained (median 63.2% and 60.9% during IA clamping, respectively; 64.0% and 65.6% during SCP, respectively). During IA clamping, right and left ScO2 decreased (median −1.4% and −1.0%, respectively). During SCP, right ΔScO2 was higher compared to left ΔScO2 (median 1.5% vs. 0.6%; p < 0.001). Eight patients had a higher right ΔScO2 than left ΔScO2 throughout SCP. They had lower ΔScO2 Rt-Lt during IA clamping (median −3.2% vs. 0.0%; p < 0.001) and higher ΔScO2 Rt-Lt during SCP than others (median 5.0% vs. −0.8%; p < 0.001). During and after SCP, the correlation coefficient between right ΔScO2 and change in the mean arterial pressure was higher in patients with a discrepancy than in others (r = 0.731 vs. r = 0.519; p < 0.001). Conclusions This study suggests that SCP permits adequate bilateral cerebral perfusion. However, the unilateral cerebral perfusion technique may cause a difference in cerebral perfusion between both hemispheres in young infants; this may depend on the perfusion pressure.