Journal ArticleDOI
Sevoflurane anesthesia and brain perfusion
O. Rhondali,Agnès Pouyau,Aurélie Mahr,Simon Juhel,Mathilde De Queiroz,Khalid Rhzioual-Berrada,Sylvain Mathews,Dominique Chassard +7 more
TLDR
To assess the impact of sevoflurane and anesthesia‐induced hypotension on brain perfusion in children younger than 6 months, a large number of patients were referred to the neonatal intensive care unit.Abstract:
SummaryObjective/Aim
To assess the impact of sevoflurane and anesthesia-induced hypotension on brain perfusion in children younger than 6 months.
Background
Safe lower limit of blood pressure during anesthesia in infant is unclear, and inadequate anesthesia can lead to hypotension, hypocapnia, and low cerebral perfusion. Insufficient cerebral perfusion in infant during anesthesia is an important factor of neurological morbidity. In two previous studies, we assessed the impact of sevoflurane anesthesia on cerebral blood flow (CBF) by transcranial Doppler (TCD) and on brain oxygenation by NIRS, in children ≤2 years. As knowledge about consequences of anesthesia-induced hypotension on cerebral perfusion in children ≤6 months is scarce, we conducted a retrospective analysis to compare the data of CBF and brain oxygenation, in this specific population.
Methods
We performed a retrospective analysis of data collected from our two previous studies. Baseline values of TCD or NIRS were recorded and then during sevoflurane anesthesia. From a database of 338 patients, we excluded all patients older than 6 months. Then, we compared physiological variables of TCD and NIRS population to ensure that the two groups were comparable. We compared rSO2c and TCD measurements variation according to MAP value during sevoflurane anesthesia, using anova and Student–Newman–Keuls for posthoc analysis.
Results
One hundred and eighty patients were included in the analysis. TCD and NIRS groups were comparable. CBF velocities (CBFV) or rSO2c reflects a good cerebral perfusion when MAP is above 45 mmHg. When MAP is between 35 and 45 mmHg, CBFV variation reflects a reduction of CBF, but rSO2c increase is the consequence of a still positive balance between CMRO2 and O2 supply. Below 35 mmHg of MAP during anesthesia, CBFV decrease and rSO2c variation from baseline is low. For each category of MAP and for the two groups, etCo2 and expired fraction of sevoflurane (FeSevo) were comparable (anova P > 0.05).
Conclusion
In a healthy infant without dehydration, with normal PaCO2 and hemoglobin value, scheduled for short procedures, MAP is a good proxy of cerebral perfusion as we found that CBF assessed by CBFV and rSO2c decreased proportionally with cerebral perfusion pressure. During 1 MAC sevoflurane anesthesia, maintaining MAP beyond 35 mmHg during anesthesia is probably safe and sufficient. But when MAP decreases below 35 mmHg, CBF decreases and rSO2c variation from baseline is low despite CMRO2 reduction. In this situation, cerebral metabolic reserve is low and further changes of systemic conditions may be poorly tolerated by the brain.read more
Citations
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Journal ArticleDOI
Differences in Blood Pressure in Infants after General Anesthesia Compared to Awake Regional Anesthesia (GAS Study - A Prospective Randomized Trial)
Mary Ellen McCann,Davinia E. Withington,Sarah J Arnup,Andrew Davidson,Andrew Davidson,Nicola Disma,Geoff Frawley,Geoff Frawley,N. S. Morton,N. S. Morton,N. S. Morton,Graham Bell,Rod W. Hunt,Rod W. Hunt,David C. Bellinger,David M. Polaner,A. Leo,Anthony Absalom,B. S. von Ungern-Sternberg,B. S. von Ungern-Sternberg,Francesca Izzo,Peter Szmuk,Vanessa Young,Sulpicio G. Soriano,J. de Graaff +24 more
TL;DR: RA reduces the incidence of hypotension and the chance of intervention to treat it compared with sevoflurane anesthesia in young infants undergoing inguinal hernia repair, and weight at the time of surgery, and minimal intraoperative temperature were risk factors for hypotension.
Journal ArticleDOI
An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia
Vanessa A. Olbrecht,Justin Skowno,Vanessa Marchesini,Lili Ding,Yifei Jiang,Christopher G. Ward,Gaofeng Yu,Huacheng Liu,Bernadette Schurink,Laszlo Vutskits,Jurgen C. de Graaff,Francis X. McGowan,Britta S. von Ungern-Sternberg,C D Kurth,Andrew Davidson +14 more
TL;DR: Mild and moderate low cerebral oxygenation occurred frequently, whereas severe low cerebral saturation was uncommon, and low mean arterial pressure was common and not well associated withLow cerebral saturation.
Journal ArticleDOI
Cerebral oximetry: the standard monitor of the future?
Anneliese Moerman,Stefan De Hert +1 more
TL;DR: NIRS offers noninvasive monitoring of cerebral and overall organ oxygenation in a wide range of clinical scenarios and there is increasing evidence that the optimized cerebral oxygenation is associated with improved outcomes in both neurologic and major organ morbidity in a variety of surgical settings.
Journal ArticleDOI
Beyond Anesthesia Toxicity: Anesthetic Considerations to Lessen the Risk of Neonatal Neurological Injury.
TL;DR: This review will summarize the main types of brain injury in preterm and term infants and their key pathways and address key potential pathogenic pathways that may be modifiable including intraoperative hypotension, hypocapnia, hyperoxia or hypoxia, hypoglycemia, and hyperthermia.
Journal ArticleDOI
A practical approach to cerebral near-infrared spectroscopy (NIRS) directed hemodynamic management in noncardiac pediatric anesthesia.
Frank Weber,Gail P. Scoones +1 more
TL;DR: A baseline c‐rSO2 value, registered in the awake child prior to anesthesia induction, is defined as the lowest acceptable limit during anesthesia and surgery, and the treatment guideline for maintaining sufficient cerebral oxygenation differs fundamentally from all previously published approaches.
References
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Journal ArticleDOI
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Piers E.F. Daubeney,S.N. Pilkington,Ellen Janke,Gareth A. Charlton,D.C. Smith,Steven A. Webber +5 more
TL;DR: The findings suggest that near-infrared spectroscopy may be a useful tool for assessing intravascular cerebral oxygenation during pediatric cardiac operations and Prospective studies of neurologic outcome will be required to establish the value of this technique for assessing the adequacy of cerebral protection.
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