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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2019.tde-18022019-152852
Document
Author
Full name
Elaine Cristina Ramos
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2018
Supervisor
Committee
Hyppolito, Miguel Angelo (President)
Anastasio, Adriana Ribeiro Tavares
Guimarães, Alexandre Caixeta
Klamt, Jyrson Guilherme
Title in Portuguese
Uso do potencial evocado auditivo de tronco encefálico como indicador de integridade neural em neonatos e lactentes submetidos à cirurgia cardíaca de alta complexidade
Keywords in Portuguese
Cirurgia cardíaca
Integridade neural
Monitorização neural
Potencial evocado auditivo de tronco encefálico
Abstract in Portuguese
Objetivo: Determinar as mudanças nas ondas dos potenciais evocados auditivos de tronco encefálico (PEATE) como indicador de integridade neural em eventos de hipoxia-isquemia cerebral em crianças submetidas à cirurgia cardíaca com circulação extracorpórea (CEC). Método: Participaram deste estudo 09 pacientes pediátricos com idade entre 0 a 2 anos, submetidos à cirurgia cardíaca de alta complexidade no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A avaliação eletrofisiológica da audição foi realizada no centro cirúrgico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, durante os respectivos momentos da cirurgia cardíaca: Sedação, Circulação Extracorpórea (CEC) e Hipotermia, e ao Final da Cirurgia, com o registro do potencial evocado auditivo de tronco encefálico (PEATE), por meio do equipamento Nicolet Endeavor CR, conectado a um notebook, duas sondas de espuma, 4 eletrodos de agulha, posicionados na mastóide direita e esquerda, vertex craniano e fronte. Resultados: As crianças tinham média de idade de 10 meses. Dessas 9 crianças, 3 do sexo feminino e 6 do sexo masculino, a média do peso foi de 6,0 Kg, as patologias e ou propostas cirúrgicas foram: Correção de Disfunção Valvar Aórtica e Tricúspide por Valvoplastia, Correção de Drenagem Anômola Total das Veias Pulmonares, Correção de Cor Triatriatum, Operação de Glenn, Implante de Marcapasso Cardíaco Intracavitário de Dupla Câmara, Correção de Disfunção Valvar Mitral por Valvoplastia, Fechamento de Comunicação Interatrial, Fechamento de Comunicação Interventricular, Bandagem e Correção da Persistência Canal Arterial. Duas dessas crianças possuem Síndrome de Down. Foi observado quanto às latências das ondas I, III e V, e seus interpicos da orelha direita e esquerda mudanças dos valores comparadas ao início com CEC e hipotermia, assim como ao início com o final da cirurgia, porém os valores foram estatisticamente não significantes, p > 0,05. Conclusão: Não foram encontradas alterações nas latências absolutas e na latência dos intervalos interpicos do PEATE para as situações de hipotermia e circulação extracorpórea.
Title in English
The use of brainstein auditory evoked response as indicator of neural integrity in newborn and infants submitted to high complexity cardiac surgery
Keywords in English
Brainstem auditory evoked potential
Cardiac surgery
Neural integrity
Neural monitoring
Abstract in English
Objective: To determine changes in the waves of brainstem evoked response audiometry (BERA) as an indicator of neural integrity in events of brain hypoxiaischemia in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Method: 09 pediatric patients aged 0 to 2 have taken part in this study, who were submitted to highly complex cardiac surgery at Hospital das Clínicas, Medical School of Ribeirão Preto. The electrophysiological assessment of hearing was performed at the surgical center of Hospital das Clínicas of the Medical School of Ribeirão Preto, during the respective moments of the cardiac surgery: Sedation, Extracorporeal Circulation (CPB) and Hypothermia, and at the End of Surgery, by recording the brainstem auditory evoked response (BERA), using the Nicolet Endeavor CR equipment, connected to a laptop, two foam probes, four needle electrodes positioned in the right and left mastoid, cranial vertex and forehead. Results: The mean age of the children was 10 months. Out of these 9 children, 3 were female and 6 were male, and their mean weight was 6.0 kg. The pathologies and or surgical proposals were: Correction of Aortic Valve Dysfunction and Tricuspid by valvuloplasty, Correction of total anomalous pulmonary venous drainage, Color Correction Triatriatum, Glenn Procedure, Double-chambered Intracavitary Cardiac Pacemaker Implantation, Mitral Valve Dysfunction Correction, Interatrial Communication Closure, Interventricular Communication Closure, Bandaging, and Correction of Persistent Arterial Canal. Two of these children have Down Syndrome. As for the latencies of the I, III and V waves and their interpeaks of the right and left ear, it was observed changes in values compared to the onset with CPB and hypothermia, as well as to the beginning with the end of surgery, but the values were not statistically significant, p > 0.05. Conclusion: No alterations were found in the absolute latencies and in the latency of the BERA intervals for situations of hypothermia and cardiopulmonary bypass.
 
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Publishing Date
2019-07-19
 
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