Newly Published
Perioperative Medicine  |   October 2017
An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia
Author Notes
  • From the Department of Anesthesiology (V.A.O., Y.J.) and Division of Biostatistics and Epidemiology (L.D.), Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; Department of Anaesthesia, Children’s Hospital at Westmead, Sydney, New South Wales, Australia (J.S.); Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia (J.S.); Anaesthesia and Pain Management Research Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia (V.M., B.S., A.D.); Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (C.G.W., F.X.M., C.D.K.); Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou, China (G.Y.); Department of Anesthesiology, Second Affiliated Hospital and Yuying Children’s Hospital of Whenzhou Medical University, Wenzhou, Zhejiang, China (H.L.); Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Victoria, Australia (B.S., A.D.); Department of Anesthesiology, Pharmacology, and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland (L.V.); Department of Anesthesiology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands (J.C.d.G.); School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia (B.S.v.U.-S.); and Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia (B.S.v.U.-S.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Part of the work presented in this article has been presented at the Society for Pediatric Anesthesia in Colorado Springs, Colorado, April 2, 2016; American Society of Anesthesia in Chicago, Illinois, October 25, 2016; and Society for Pediatric Anesthesia in Austin, Texas, March 4, 2017. V.A.O. and J.S. contributed equally to this article.
    Part of the work presented in this article has been presented at the Society for Pediatric Anesthesia in Colorado Springs, Colorado, April 2, 2016; American Society of Anesthesia in Chicago, Illinois, October 25, 2016; and Society for Pediatric Anesthesia in Austin, Texas, March 4, 2017. V.A.O. and J.S. contributed equally to this article.×
  • Submitted for publication February 28, 2017. Accepted for publication September 11, 2017.
    Submitted for publication February 28, 2017. Accepted for publication September 11, 2017.×
  • Acknowledgments: The authors thank Christopher Brasher, F.A.N.Z.C.A. (Department of Anesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Victoria, Australia); Jack Luxford, B.A. (Sydney Medical School, Sydney, New South Wales, Australia); Michaela Turancova, B.Sc. (University of Sydney, Sydney, New South Wales, Australia); Lara Oversby, R.N. (Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia); Thomas Drake-Brockman, B.Phil. (Hons.) (Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children and School of Medicine, University of Western Australia, Perth, Western Australia, Australia); and Lliana Slevin, B.Sc. (Hons.) Pharmacology (Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children and Children’s Lung Group, Telethon Kids Institute, Perth, Western Australia, Australia).
    Acknowledgments: The authors thank Christopher Brasher, F.A.N.Z.C.A. (Department of Anesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Victoria, Australia); Jack Luxford, B.A. (Sydney Medical School, Sydney, New South Wales, Australia); Michaela Turancova, B.Sc. (University of Sydney, Sydney, New South Wales, Australia); Lara Oversby, R.N. (Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia); Thomas Drake-Brockman, B.Phil. (Hons.) (Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children and School of Medicine, University of Western Australia, Perth, Western Australia, Australia); and Lliana Slevin, B.Sc. (Hons.) Pharmacology (Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children and Children’s Lung Group, Telethon Kids Institute, Perth, Western Australia, Australia).×
  • Research Support: 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).
    Research Support: 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).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Olbrecht: Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, Ohio 45229. Vanessa.Olbrecht@cchmc.org. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Pediatric Anesthesia / Respiratory System
Perioperative Medicine   |   October 2017
An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia
Anesthesiology Newly Published on October 19, 2017. doi:10.1097/ALN.0000000000001920
Anesthesiology Newly Published on October 19, 2017. doi:10.1097/ALN.0000000000001920
Abstract

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.