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, Charles Dean Kurth, Andrew Davidson

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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.

Original languageEnglish
Pages (from-to)85-96
Number of pages12
JournalAnesthesiology
Volume128
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

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General Anesthesia
Multicenter Studies
Observational Studies
Arterial Pressure
Oximetry
Anesthesia
Brain Hypoxia-Ischemia
Anesthesiology
Near-Infrared Spectroscopy
Incidence
Anesthetics
Oxygen

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Olbrecht, V. A., Skowno, J., Marchesini, V., Ding, L., Jiang, Y., Ward, C. G., ... Davidson, A. (2018). An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia. Anesthesiology, 128(1), 85-96. https://doi.org/10.1097/ALN.0000000000001920
Olbrecht, Vanessa A. ; Skowno, Justin ; Marchesini, Vanessa ; Ding, Lili ; Jiang, Yifei ; Ward, Christopher G. ; Yu, Gaofeng ; Liu, Huacheng ; Schurink, Bernadette ; Vutskits, Laszlo ; De Graaff, Jurgen C. ; McGowan, Francis X. ; Von Ungern-Sternberg, Britta S. ; Kurth, Charles Dean ; Davidson, Andrew. / An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia. In: Anesthesiology. 2018 ; Vol. 128, No. 1. pp. 85-96.
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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.",
author = "Olbrecht, {Vanessa A.} and Justin Skowno and Vanessa Marchesini and Lili Ding and Yifei Jiang and Ward, {Christopher G.} and Gaofeng Yu and Huacheng Liu and Bernadette Schurink and Laszlo Vutskits and {De Graaff}, {Jurgen C.} and McGowan, {Francis X.} and {Von Ungern-Sternberg}, {Britta S.} and Kurth, {Charles Dean} and Andrew Davidson",
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Olbrecht, VA, Skowno, J, Marchesini, V, Ding, L, Jiang, Y, Ward, CG, Yu, G, Liu, H, Schurink, B, Vutskits, L, De Graaff, JC, McGowan, FX, Von Ungern-Sternberg, BS, Kurth, CD & Davidson, A 2018, 'An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia' Anesthesiology, vol. 128, no. 1, pp. 85-96. https://doi.org/10.1097/ALN.0000000000001920

An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia. / Olbrecht, Vanessa A.; Skowno, Justin; Marchesini, Vanessa; Ding, Lili; Jiang, Yifei; Ward, Christopher G.; Yu, Gaofeng; Liu, Huacheng; Schurink, Bernadette; Vutskits, Laszlo; De Graaff, Jurgen C.; McGowan, Francis X.; Von Ungern-Sternberg, Britta S.; Kurth, Charles Dean; Davidson, Andrew.

In: Anesthesiology, Vol. 128, No. 1, 01.01.2018, p. 85-96.

Research output: Contribution to journalArticle

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

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.

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U2 - 10.1097/ALN.0000000000001920

DO - 10.1097/ALN.0000000000001920

M3 - Article

VL - 128

SP - 85

EP - 96

JO - Anethesiology

JF - Anethesiology

SN - 0003-3022

IS - 1

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