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JOURNAL ARTICLE
Cerebral regional oxygen saturation: a useful monitor during a surgical procedure involving the right-sided aortic arch in an infant.
Journal of Anesthesia 2019 December
A right aortic arch with an aberrant left subclavian artery and a Kommerell's diverticulum represents a rare anatomic variant carrying the risk of dissection or rupture. Resection of the diverticulum and re-implantation of the left subclavian artery during childhood have been recommended. Because of the risk of cerebral blood flow reduction during the aberrant subclavian artery re-implantation to the common carotid artery, monitoring and prompt measures to curb blood flow reduction are required. A 5-month-old boy was scheduled to undergo resection surgery. During the translocation of the aberrant subclavian artery to the common carotid artery, his regional oxygen saturation (rSO2 ) in the left cerebrum began to decrease. We increased the end-tidal CO2 (EtCO2 ), mean arterial pressure, and a fraction of inspired oxygen, successfully restoring the rSO2 to the initial level. No postoperative neurological complications were observed. Our experience with this patient suggests that rSO2 monitoring is a useful, and intervention protocol including hypercapnia, elevated mean arterial pressure, and hyperoxia to counter the decreased cerebral blood flow is effective in infant patients undergoing right-sided aortic arch surgery.
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