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The effect of spinal anesthesia on cerebral saturation measured by Near Infrared Spectroscopy
Abstract Number: SA-19
Abstract Type: Original Research
Objective: The effect of spinal anesthesia (SA) on cerebral saturation (COx) has never been studied. We aimed to measure brain saturation and discover if cerebral saturation correlates with changes in blood pressure.
Methods: A prospective observational study with measurement of right and left-sided brain saturation (COxR and COxL respectively) in healthy women undergoing scheduled cesarean section (SCS) using Near Infrared Spectroscopy (INVOS Cerebral/Somatic Oximeter|Covidien) - a direct non-invasive measurement of blood oxygenation in the brain microvasculature that has shown a high level of accuracy and can be used to detect an index of brain oxygenation(1).The measurements were done at the following points: preoperatively in supine position (SP), preoperatively in the sitting position, sitting during local anesthesia for SA, sitting at the end of SA, supine 1 minute postspinal (1m), supine 5 minute postspinal (5m), at skin incision (SI), after baby delivered (BD),1 minute after beginning of oxytocin infusion (ox), surgery completion and 1 hour after surgery(PACU1). Women underwent SA using bupivacaine 12 mg, fentanyl 20 µg and morphine 0.1 mg with a prophylactic phenylephrine infusion of 50 µg/min from beginning of SA to the end of surgery. Immediately after delivery, oxytocin 20 units was injected into a liter of Ringer Lactate and infused. No other uterotonics were given.
Results: 50 women were studied. Average age was 33.9±5.8 years and weight 72.2±11.6 kg. There was no significant correlation between changes in blood pressures and changes in COxR and COxL. There was no significant correlation between blood pressures and COx at each point. There was no significant difference between changes in COxR and COxL. There were significant drops in COxL and COxR compared with SP at 5m, SI, BD, ox and PACU1 (figure 1).
Figure 1: Cerebral saturation (left and right side) measured by INVOS at different points in time.
Brain saturation significantly decreased after spinal anesthesia with maximum at 5 minute postspinal and did not return to baseline even 1 hour after the surgery with no significant correlation with blood pressure changes. Further studies are required to assess the exact cause and clinical significance of these changes.
1)Near-infrared spectroscopy as an index of brain and tissue oxygenation. Murkin JM, Br J Anaesth.,2009