TY - JOUR
T1 - An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia
AU - Olbrecht, Vanessa A.
AU - Skowno, Justin
AU - Marchesini, Vanessa
AU - Ding, Lili
AU - Jiang, Yifei
AU - Ward, Christopher G.
AU - Yu, Gaofeng
AU - Liu, Huacheng
AU - Schurink, Bernadette
AU - Vutskits, Laszlo
AU - De Graaff, Jurgen C.
AU - McGowan, Francis X.
AU - Von Ungern-Sternberg, Britta S.
AU - Kurth, Charles Dean
AU - Davidson, Andrew J.
N1 - Funding Information:
Supported by Australian and New Zealand College of Anaesthetists Project Grant 15/021 (West End, Queensland, Australia) and Society of Pediatric Anaesthetists of New Zealand and Australia Research Grant 2016 (Morrisett, New South Wales, Australia), as well as the Princess Margaret Hospital Foundation (to Dr. von Ungern-Sternberg; Perth, Western Australia, Australia), the Callahan Estate (to Dr. von Ungern-Sternberg; Perth, Western Australia, Australia), and the Stan Perron Fellowship (to Dr. von Ungern-Sternberg; Perth, Western Australia, Australia).
Publisher Copyright:
Copyright © 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia-ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants. Methods: This multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy. We defined events (more than 3 min) for low cerebral oxygenation as mild (60 to 69% or 11 to 20% below baseline), moderate (50 to 59% or 21 to 30% below baseline), or severe (less than 50% or more than 30% below baseline); for low mean arterial pressure as mild (36 to 45 mmHg), moderate (26 to 35 mmHg), or severe (less than 25 mmHg); and low pulse oximetry saturation as mild (80 to 89%), moderate (70 to 79%), or severe (less than 70%). Results: The incidences of mild, moderate, and severe low cerebral oxygenation were 43%, 11%, and 2%, respectively; mild, moderate, and severe low mean arterial pressure were 62%, 36%, and 13%, respectively; and mild, moderate, and severe low arterial saturation were 15%, 4%, and 2%, respectively. Severe low oxygen saturation measured by pulse oximetry was associated with mild and moderate cerebral desaturation; American Society of Anesthesiology Physical Status III or IV versus I was associated with moderate cerebral desaturation. Severe low cerebral saturation events were too infrequent to analyze. Conclusions: Mild and moderate low cerebral saturation occurred frequently, whereas severe low cerebral saturation was uncommon. Low mean arterial pressure was common and not well associated with low cerebral saturation. Unrecognized severe desaturation lasting 3 min or longer in infants seems unlikely to explain the subsequent development of neurocognitive abnormalities.
AB - Background: General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia-ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants. Methods: This multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy. We defined events (more than 3 min) for low cerebral oxygenation as mild (60 to 69% or 11 to 20% below baseline), moderate (50 to 59% or 21 to 30% below baseline), or severe (less than 50% or more than 30% below baseline); for low mean arterial pressure as mild (36 to 45 mmHg), moderate (26 to 35 mmHg), or severe (less than 25 mmHg); and low pulse oximetry saturation as mild (80 to 89%), moderate (70 to 79%), or severe (less than 70%). Results: The incidences of mild, moderate, and severe low cerebral oxygenation were 43%, 11%, and 2%, respectively; mild, moderate, and severe low mean arterial pressure were 62%, 36%, and 13%, respectively; and mild, moderate, and severe low arterial saturation were 15%, 4%, and 2%, respectively. Severe low oxygen saturation measured by pulse oximetry was associated with mild and moderate cerebral desaturation; American Society of Anesthesiology Physical Status III or IV versus I was associated with moderate cerebral desaturation. Severe low cerebral saturation events were too infrequent to analyze. Conclusions: Mild and moderate low cerebral saturation occurred frequently, whereas severe low cerebral saturation was uncommon. Low mean arterial pressure was common and not well associated with low cerebral saturation. Unrecognized severe desaturation lasting 3 min or longer in infants seems unlikely to explain the subsequent development of neurocognitive abnormalities.
UR - http://www.scopus.com/inward/record.url?scp=85037994068&partnerID=8YFLogxK
U2 - 10.1097/ALN.0000000000001920
DO - 10.1097/ALN.0000000000001920
M3 - Article
C2 - 29019815
AN - SCOPUS:85037994068
SN - 0003-3022
VL - 128
SP - 85
EP - 96
JO - Anesthesiology
JF - Anesthesiology
IS - 1
ER -