Influence of external cardiac pacing on cerebral oxygenation measured by near infrared spectroscopy in children after cardiac surgery

Thilo Pierre Karl Fleck (1) , Stephan Schubert (2) , Matthias Redlin (3) , Brigitte Stiller (4) , Peter Ewert (2) , Felix Berger (2) , Nicole Nagdyman (2)

1 Department of Congenital Heart Disease / Paediatric Cardiology
2 Department of Congenital Heart Disease / Paediatric Cardiology
3 Department of Anaesthesiology [Berlin]
4 Department of Congenital Heart Defects and Paediatric Cardiology, Center for Paediatrics

Background: The brain of children in the early period after repair of congenital heart defects with cardiopulmonary bypass (CPB) may be more vulnerable to hemodynamic changes because of impaired cerebral autoregulation. During postoperative testing of the external temporary safety pacer we performed desynchronizing ventricular pacing (VVI) while monitoring cerebral oxygenation using near-infrared spectroscopy (NIRS). Methods: We prospectively investigated 11 children (6 female, 5 male). Mean age was 6.1 months (± 3.8 months) and mean weight: 5.3 kg (± 1.5 kg). We performed measurements at four study steps: 1. baseline I, 2. VVI pacing, 3. baseline II, and 4. atrial pacing (AOO) in order to exclude effects of higher heart rate. We continuously measured the effects on hemodynamic and respiratory parameters as well as on cerebral tissue oxygenation index (TOI). Hemoglobin difference (HbD) was calculated as a parameter for cerebral blood flow. Results: VVI pacing leads to a significant decrease in arterial blood pressure and central venous saturation accompanied by an immediate and significant decrease in TOI (63.3 % ± 7.6% to 61.5% ± 8.4% (p<0.05)) and HbD (0.51 ± 1.8 µmol/l to –2.9 ± 4.7 µmol/l (p< 0.05)). Conclusion: Cardiac desynchronization after CPB seems to reduce cerebral blood flow and cerebral oxygenation in children.

Mots clés: Medicine

Thilo Pierre Karl Fleck, Stephan Schubert, Matthias Redlin, Brigitte Stiller, Peter Ewert, et al.. Influence of external cardiac pacing on cerebral oxygenation measured by near infrared spectroscopy in children after cardiac surgery. Pediatric Anesthesia, 2010, 20 (6), pp.576. ⟨10.1111/j.1460-9592.2010.03304.x⟩. ⟨hal-00552642⟩