Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years

Rhondali, O.; Juhel, Simon; Mathews, Sylvain; Cellier, Quentin; Desgranges, François-Pierrick; Mahr, A.; Queiroz, Mathilde De; Pouyau, A.; Rhzioual-Berrada, Khalid; Chassard, D.

doi:10.1111/pan.12397

Cited by 57 publications

(53 citation statements)

References 26 publications

(31 reference statements)

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“…Nonetheless, a recent study described positive association of intraoperative blood pressure and rSO 2 c values in a cohort of anesthetized infants up to 3 months of age [11]. In anesthetized patients, O. Rhondali et al found that the higher the absolute MAP was during anesthesia, the higher the rSO 2 c was [6, 7]. …”

Section: Discussionmentioning

confidence: 99%

“…In 2011, Kasman N and Brady K in a review article summarized the existing evidence relating cerebral desaturation events to neurological outcome in children who had undergone cardiac surgery [5]. A few recent studies addressed the issue of adequate blood pressure based on cerebral oxygenation monitoring in children under inhaled general anesthesia with sevoflurane [6, 7]. But, so far, there is no sufficient evidence to support the routine use of NIRS during general surgical procedures in children.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of risk factors for cerebral oxygen desaturation during neonatal and infant general anesthesia: an observational, prospective study

et al. 2016

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Background: Cerebral oxygen saturation (rSO 2 c) decrease from baseline greater than 20 % during infant cardiac surgery was associated with postoperative neurologic changes and neurodevelopmental impairment at 1 year of age. So far, there is no sufficient evidence to support the routine monitoring of rSO 2 c during general surgical procedures in children. We aimed to find out the frequency of cerebral desaturation 20 % or more from baseline and to identify possible predictors of change in cerebral oxygen saturation during neonatal and infant general surgery. Methods: Forty-four infants up to 3 months of age were recruited. Before induction of anesthesia, two pediatric cerebral sensors were placed bilaterally to the forehead region and monitoring of regional cerebral saturation of oxygen was started and continued throughout the surgery. Simultaneously, mean arterial blood pressure (MAP), pulse oximetry (SpO 2 ), heart rate (HR), endtidal CO 2 , expired fraction of sevoflurane and rectal temperature were recorded. The main outcome measure was rSO 2 c value drop-off ≥20 % from baseline. Mann-Whitney U-test, chi-squared test, simple and multiple linear regression models were used for statistical analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of risk factors for cerebral oxygen desaturation during neonatal and infant general anesthesia: an observational, prospective study

et al. 2016

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“…[31527] We found an SO 2 < 5% reduction in brain tissue saturation in children during routine laparoscopy; thus long-term neurological outcome should be evaluated in children and particularly in infants whose cerebral metabolic reserve seems to be lower and poorly tolerated by the brain. [2829]…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair

et al. 2017

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BACKGROUND:The systemic impact of intra-abdominal pressure (IAP) and/or changes in carbon dioxide (CO2) during laparoscopy are not yet well defined. Changes in brain oxygenation have been reported as a possible cause of cerebral hypotension and perfusion. The side effects of anaesthesia could also be involved in these changes, especially in children. To date, no data have been reported on brain oxygenation during routine laparoscopy in paediatric patients.PATIENTS AND METHODS:Brain and peripheral oxygenation were investigated in 10 children (8 male, 2 female) who underwent elective minimally invasive surgery for inguinal hernia repair. Intraoperative transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation using pulse oximetry and heart rate (HR) were monitored at five surgical intervals: Induction of anaesthesia (baseline T1); before CO2 insufflation induced pneumoperitoneum (PP) (T2); CO2 PP insufflation (T3); cessation of CO2 PP (T4); before extubation (T5).RESULTS:rScO2 decreases were recorded immediately after T1 and became significant after insufflation (P = 0.006; rScO2 decreased 3.6 ± 0.38%); restoration of rScO2 was achieved after PP cessation (P = 0.007). The changes in rScO2 were primarily due to IAP increases (P = 0.06). The HR changes were correlated to PP pressure (P < 0.001) and CO2 flow rate (P = 0.001). No significant peripheral effects were noted.CONCLUSIONS:The increase in IAP is a critical determinant in cerebral oxygenation stability during laparoscopic procedures. However, the impact of anaesthesia on adaptive changes should not be underestimated. Close monitoring and close collaboration between the members of the multidisciplinary paediatric team are essential to guarantee the patient's safety during minimally invasive surgical procedures.

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“…Therefore, pediatric patients might be at risk for cerebral ischemia or hyperemic injury when blood pressure crosses below the lower limit of autoregulation, or exceeds the upper limit of autoregulation, respectively [45,46 & ]. Particularly neonates are at considerable risk of physiological disturbances, eventually leading to neurologic impairment [47,48]. These issues inquire about how to select safe hemodynamic goals in children.…”

Section: Pediatric Surgerymentioning

confidence: 99%

“…However, few recent studies have described the use of NIRS in children during noncardiac surgery. Rhondali et al [45,48] used NIRS to assess the impact of sevoflurane and anesthesia-induced hypotension on brain perfusion. An observational study in infants treated for esophageal atresia indicated that NIRS represents a good monitor of hemodynamic changes, and might therefore guide perioperative care [49 & ].…”

Section: Pediatric Surgerymentioning

confidence: 99%

Cerebral oximetry

Moerman

Hert

2015

Current Opinion in Anaesthesiology

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Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years

Cited by 57 publications

References 26 publications

Assessment of risk factors for cerebral oxygen desaturation during neonatal and infant general anesthesia: an observational, prospective study

Assessment of risk factors for cerebral oxygen desaturation during neonatal and infant general anesthesia: an observational, prospective study

Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair

Cerebral oximetry

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