Changes in Intra-cerebral Environment in Patients Undergoing Tracheotomy: An Original Research Satoh Kenichi1,*, Chikuda Mami1, Ohashi Ayako1, Kumagai Miho2, Sato Masahito1, Joh Shigeharu1 1Department of Reconstructive Oral and Maxillofacial Surgery, Division of Dental Anesthesiology, School of Dentistry, Iwate Medical University, Iwate, 020–8505, Japan 2Department of Developmental Oral Health Science, Division of Special Care Dentistry, School of Dentistry, Iwate Medical University, Iwate, 020–8505, Japan *Address for correspondence: Kenichi Satoh, Department of Reconstructive Oral and Maxillofacial Surgery, Division of Dental Anesthesiology, School of Dentistry, Iwate Medical University, 1-3-27 Chuo-dori, Morioka, Iwate 020–8505, Japan. Tel.: +81-19-6515111 (ext. 4331), Fax: +81-19-6520756, E-mail: satoken@iwate-med.ac.jp
Online published on 14 September, 2015. Abstract Background and Objectives Microvascular flap reconstruction has recently proven to be very reliable for repairing defects in the oral and maxillofacial cavity defects. Such patients often require a tracheotomy to stay in the intensive care unit post-operatively. Although tracheotomy is usually performed after oral intubation, details of the intra-cerebral oxygenation environment during tracheotomy are unclear. Using near-infrared spectroscopy, we investigated the changes in intra-cerebral oxygenation during exchange from oral to tracheal intubation in patients undergoing tracheotomy. Materials and Methods We evaluated eight patients with an American Society of Anesthesiologists physical Status of I or II who were scheduled to undergo tracheotomy. Changes in the intra-cerebral levels of oxyhemoglobin (oxy-Hb), deoxyhemoglobin (deoxy-Hb), total hemoglobin (total-Hb), and cytochrome oxidase (cyt) were monitored during tracheotomy. Results Blood pressure increased rapidly during exchange from an oral to tracheal intubation tube. The maximum oxy-Hb level (3.5 ± 2.4 nmol/L) occurred 5 min after the exchange, the maximum deoxy-Hb level (0.8 ± 1.0 nmol/L) occurred 5 min after the exchange, the maximum total-Hb level (1.8 ± 2.2 nmol/L) occurred 5 min after the exchange, and the minimum cyt level (−0.5 ± 0.2 nmol/L) occurred 7 min after the start of the operation. Conclusions The intra-cerebral oxy-Hb and total-Hb levels increased after exchange from an oral to tracheal intubation tube during tracheotomy, and these hemodynamic changes attenuated the cerebral blood flow. Top Keywords Intra-cerebral environment, oral and maxillofacial surgery, oxyhemoglobin, total hemoglobin, tracheotomy. Top |