Use of transcranial Doppler ultrasonography and jugular

J Clin Neurosci · Dec 2010

Case Reports

Use of transcranial Doppler ultrasonography and jugular oximetry to optimize hemodynamics during pediatric posterior fossa craniotomy.

We describe a 13-year-old child who developed inadvertent intraoperative cerebral oxygen desaturation attributed to empiric hyperventilation during posterior fossa craniotomy, diagnosed by jugular venous oximetry. Although restoration of normocapnia at age-appropriate mean arterial blood pressure improved jugular venous saturation (SjvO), it remained below acceptable values. Transcranial-Doppler (TCD) ultrasonography-guided stepwise increase in mean arterial pressure led to a linear increase in the mean flow velocity of the middle cerebral artery and SjvO₂ to desirable values. Intraoperative SjvO₂ monitoring and TCD ultrasonography may be utilized together to individualize hemodynamic targets and ventilation parameters and maintain adequate cerebral oxygenation during paediatric craniotomies.

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- Deepak Sharma, Richard G Ellenbogen, and Monica S Vavilala.
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA.
- J Clin Neurosci. 2010 Dec 1; 17 (12): 1583-4.
AbstractWe describe a 13-year-old child who developed inadvertent intraoperative cerebral oxygen desaturation attributed to empiric hyperventilation during posterior fossa craniotomy, diagnosed by jugular venous oximetry. Although restoration of normocapnia at age-appropriate mean arterial blood pressure improved jugular venous saturation (SjvO), it remained below acceptable values. Transcranial-Doppler (TCD) ultrasonography-guided stepwise increase in mean arterial pressure led to a linear increase in the mean flow velocity of the middle cerebral artery and SjvO₂ to desirable values. Intraoperative SjvO₂ monitoring and TCD ultrasonography may be utilized together to individualize hemodynamic targets and ventilation parameters and maintain adequate cerebral oxygenation during paediatric craniotomies.Copyright © 2010 Elsevier Ltd. All rights reserved.

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Use of transcranial Doppler ultrasonography and jugular oximetry to optimize hemodynamics during pediatric posterior fossa craniotomy.

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