Usefulness of bilateral cerebral regional oxygen saturation measurements in determining selective cerebral perfusion flow rate in a pediatric patient with aortic arch stenosis: a case report.

Background: We report a pediatric case where bilateral regional oxygen saturation (rSO) measurements were useful in determining the selective cerebral perfusion (SCP) flow rate.

Case Presentation: A 9-year-old Japanese boy, 128 cm tall and weighing 25.6 kg, was scheduled for aortic arch reconstruction due to a 90-100 mmHg pressure gradient. Pediatric-sized oximetry sensors were attached to the bilateral forehead area. The rSO levels were 70-80% on the right and 80-90% on the left during cardiopulmonary bypass. Immediately following deep hypothermic circulatory arrest with the body temperature cooled to 25 °C, SCP was initiated from the right brachiocephalic artery at 10 mL/kg/min. As the rSO decreased steeply to 43-45% on the right and to 32-38% on the left, the SCP flow was increased to 15 mL/kg/min. The right rSO increased promptly to 50-60%, but the left rSO remained at 30-40%. After the SCP flow was increased to 20 mL/kg/min, bilateral rSO levels of 50-60% were obtained, and the SCP flow rate was maintained. The patient was transferred to the ICU postoperatively and extubated on the second postoperative day with no neurological abnormalities.

Conclusions: Bilateral rSO measurements are essential even for a pediatric patient undergoing SCP, despite the limited forehead area.