Ilona Razlevičė, Danguolė Rugytė, Andrius Macas
The aim of our study was to evaluate the influence of perioperative period (first 24 hours) on brain specific proteins S100B and NSE concentration in plasma and to correlate it with intraoperative cerebral oxygen saturation (rSO2c) in neonates and infants, Methods: The prospective observational clinical study included 46 newborns and infants younger than 3 months. All patients required elective or urgent abdominal, urological, thoracic or other major general surgery. After arrival to the OR, standard monitoring was started before anesthesia. All patients underwent general anesthesia with tracheal intubation and controlled ventilation. Monitoring of regional cerebral saturation of oxygen was started before anesthesia and data were captured throughout the surgery. Blood samples for plasma S100B and NSE analysis were collected before surgery and 24 h after the operation. The difference between markers initial (before anesthesia) values and 24 h after operation was calculated and expressed as a percent of the initial value (delta S100B%, delta NSE%). Results: 46 patients were enrolled in this study. 24 h after operation we found that S100B increased in 10 (21.7%) and NSE in 11 (23.9%) neonates. Delta NSE and delta S100B well correlated r=0.5, p=0.002. Delta S100B% correlated with rSO2c r=0.42, p=0.004 and with mean arterial pressure (MAP) r=-0.3, p=0.04. The correlation was also observed between rSO2c and MAP r=0.3, p=0.037. We did not find statistically significant relationship between the brain specific markers and abnormal neurosonography. In conclusion, 24 h after operation for the vast majority of patients brain cell damage or increased brain blood barrier permeability, which could result in increased concentration of brain specific proteins, did not occur. However, increased S100B values were observed in infants with presumable brain hyperoxia (rSO2c >85%). Diminished arterial blood pressure may affect newborns and infants cerebral oxygenation and cause higher release of brain cell damage proteins perioperatively.
Keyword(s): brain injury markers; neonates; general anesthesia; cerebral oxygenation; S100B; NSE.
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