Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults

Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study

“…In a pediatric population undergoing non‐cardiac surgery, in particular, data on the usefulness of intraoperative measurements of rScO 2 are lacking. In a recent systematic review on the use of NIRS for perioperative monitoring of brain oxygenation in adults and children, Yu et al identified 15 randomized controlled trials in this field. Their finding was that there was an uncertainty as to whether cerebral NIRS has an important effect on postoperative stroke, delirium, death or cognitive dysfunction However, none of these trials included children and the authors concluded that randomized controlled trials in a pediatric population are needed before it can be recommended as a monitoring device …”

“…It is not immediately obvious why we could not demonstrate that values of frontal and occipital rScO2 were almost identical in all patients? One could speculate that measurement errors may appear because of the position of the head (neck extension), movement of the head, surgical manipulation of the head, light from the environment (eg, operation lamp), poor sensor attachment and other unknown measurement errors . One could also speculate that the high inspired oxygen during preoxygenation and sevoflurane may have quantitatively different regional effects on cerebral oxygenation …”

“…Sensors are placed at fixed distances from a light emitter, and algorithms subtract superficial light absorption from deep absorption to provide an index of tissue oxygenation . Although the popularity of NIRS monitoring is growing, definitive data that prove outcome benefits with its use remain sparse . In addition, another risk area which also is closely investigated is the brain response to anesthesia exposure early in life.…”

Neurologic outcomes after heart surgery

“…A recent Cochrane Review looked at cerebral NIRS for perioperative monitoring of brain oxygenation and found that perioperative NIRS monitoring had an uncertain effect on reducing short‐term, mild postoperative cognitive decline due to low quality of evidence. None of the studies included in the Cochrane review used pediatric cohorts.…”

Is cerebral monitoring useful? Focus must shift from mere observation to testing interventions

“…Dr Lassen defined the static cerebral autoregulation curve in 1959, Dr Aaslid gave insight into the dynamic autoregulation by transcranial Doppler ((TCD); 1982) while Dr Jöbsis described cerebral oximetry ((NIRS); 1977) . Some have argued the business truism “if you cannot measure it, you cannot manage it.” Despite optimism for utility of NIRS and TCD as non‐invasive assessment tools for cerebral well‐being, the evidence to support treatment decisions based on these measures remains sparse …”