Assessment of the oxygen status of the brain during the oral cavity sanation in children aged 3–7 years under general anesthesia on an outpatient setting
Authors: Koval O. I. 
Published: November 2019

Summary. Unfortunately, today, mental and behavioral disorders in children are quite common. It is proved that one of the main causes of cognitive decline is the disease of the small vessels of the brain. In the literature, there are data on the study of the relationship of cognitive impairment due to functional changes on the background of oxygen starvation of the brain.

The aim of the study – the article presents the rationale for the need to limit the time for oral rehabilitation in an outpatient setting under general anesthesia in order to preserve the cognitive functions of the brain of the child due to its functional changes in violation of the oxygen status of cerebral vessels.

Materials and Methods. The oral cavity sanation in the conditions of general anesthesia was conducted in 39 children aged 3–7 years on the basis of the Dental Medical Center at the National Medical University named after O. O. Bohomolets. This age group of children according to the classification of temperament (Thomas and Chess, 1997) includes: 11 children with “mild” temperament; 19 children – with «difficult» temperament; 9 children – temperament «long warms up». In order to monitor the oxygen status of the brain, cerebral oximetry was used.

Results and Discussion. The linear decrease of rSO2 occurs from 43 minutes. To 60 min. rSO2 = (58.6±0.01) %, with a possible minimum value of 60.26 %. Min rSO2 within the normal range = (60.26±0.22) % is between 57 and 58 minutes. Therefore, in order to prevent the occurrence of brain hypoxia, dental rehabilitation of the oral cavity for children aged 3–7 years should be performed within (40±15) min. Respiratory complications (laryngospasm) in 10.25 % of children were noted during the rehabilitation of the oral cavity under general anesthesia. The mean rSO2 for laryngospasm is (68.83±7.39) %, which is 8.63 % relative to the mean rSO2 of the respective age group (rSO2 = (75.33±2.68) %). SO rSO2 of 16 min. 33 minutes each (≤20 min) by 11.42 % (rSO2 = (60.57±5.44) %). The peak of the decline occurred in 20–21 min. (rSO2 = (53.5±2.45 %) and accounted for 28.97 % of the total group value and 11.67 % of rSO2 directly for laryngospasm. In 75 % of children who had complications in the form of laryngospasm during the rehabilitation of the oral cavity under general anesthesia were noted ≤ 2 weeks after complete recovery for acute respiratory diseases (ARD). In order to study the effect of inflammatory processes of the respiratory tract on the possibility of complications in the process of dental rehabilitation in the outpatient setting under general anesthesia, we selected a group of children who had a history of ≥2 weeks but ≤ 4 weeks (group I) and analyzed the results indices of rSO2 with a group of children who had a history of ARD with a history of ≤ 2 weeks (group II) relative to those of rSO2 in the general group of children aged 3–7 years (group III). rSO2 in children of group I – (68.65±7.72) % ↓ rSO2 from 16 min to 32 minutes (≤20 min) is 14.59 % (rSO2 = (58.63±4.55) %). In the group II of children, rSO2 (74.92±6.84) %) coincides with rSO2 (74.84±6.63) %) in group III.

Conclusions. Dental sanitation of the oral cavity under general anesthesia on an outpatient basis for children aged 3–7 years has a time limit (40±15) min. A contraindication for routine oral sanitation under general anesthesia on an outpatient basis is the presence of acute respiratory infections in the history of ≤ 2 weeks. In acute dental conditions, if there is a history of acute respiratory infections ≤ 2 weeks, ambulance care on an outpatient basis under general anesthesia is possible within 15 minutes. SpO2 values do not correlate with rSO2 indicators. The method of cerebral oximetry makes it possible to early detect changes in the oxygen balance of the brain and support it in time. The method of cerebral oximetry makes it possible to early detect changes in the oxygen balance of the brain and support it in time.