PMID- 37933584 OWN - NLM STAT- MEDLINE DCOM- 20240104 LR - 20240329 IS - 1460-9592 (Electronic) IS - 1155-5645 (Linking) VI - 34 IP - 2 DP - 2024 Feb TI - The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study. PG - 138-144 LID - 10.1111/pan.14789 [doi] AB - INTRODUCTION: Cerebral oxygen desaturation during pediatric surgery has been associated with adverse perioperative outcomes. The aim of this pilot study was to analyze the frequency and severity of intraoperative cerebral oxygen desaturations and their impact on postoperative cerebral oxygen metabolism in neonates and infants undergoing pediatric surgery. METHODS: In a prospective pilot study, intra- and postoperative regional cerebral oxygen saturation and blood flow were measured noninvasively using a device combining laser Doppler flowmetry and white-light-spectrometry. Thirty-seven consecutive neonates and infants undergoing noncardiac surgery under general anesthesia for more than 30 min and necessity for invasive arterial blood pressure monitoring were included. Patients with pre-known congenital structural heart disease or cerebral disease were excluded. Continuously brain monitor recording was started in sedated patients before induction of anesthesia (preoperative baseline) and was completed 1 h postoperatively in the PICU in sedated, intubated, and mechanically ventilated states at the PICU (postoperative state). Baseline and postoperative state for cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen were calculated. RESULTS: Seventeen (46%) of the 37 studied neonates and infants suffered from intraoperative periods of regional cerebral oxygen desaturation below 20% of the baseline (event group). Severity of cerebral desaturations was median 4.0%min/h [range 0.1-58.7; interquartile range [IQR] 0.99-21.29]. In the event group, the duration of surgery was significantly longer (median 135 min [range 11-260; IQR 113.5-167.0] vs median 46.5 min [range 11-180; IQR 30.5-159.3]; difference of -62.94; 95% confidence interval [CI] -105.17 to -20.71; p = .021). In the event group, cerebral fractional tissue oxygen extraction (median 0.41 [range 0.20-0.55; IQR 0.26-0.44] vs. median 0.27 [range 0.11-0.41; IQR 0.20-0.31]; difference of -0.11; 95% CI -0.17 to -0.05; p = .001) and approximated cerebral metabolic rate of oxygen (median 6.15 arbitrary unit [range 2.69-12.07; IQR 5.12-7.21] vs. median 4.14 arbitrary unit [range 1.78-7.86; IQR 3.82-6.31]; difference of -1.76; 95% CI -3.03 to -0.49; p = .009) were significantly higher and the cerebral regional oxygen saturation (median 58.99% [range 44.87-79.1; IQR 54.26-72.61] vs median 70.94% [range 57.9-86.13; IQR 67.07-76.59]; difference of 10.01; 95% CI 4.13-15.90; p = .002) significantly lower after surgery compared to the nonevent group. DISCUSSION: The increase of approximated cerebral metabolic rate of oxygen could indicate an elevated oxidative energy metabolism in the "stressed" brain, due to repair processes. The increased cerebral fractional tissue oxygen extraction fits with the decreased NIRS cerebral oxygenation. Our data suggest that an increase in cerebral oxygen metabolism was the cause. CONCLUSION: Cerebral oxygen desaturation during major surgery in neonates and infants is associated with early postoperative increased cerebral oxygen extraction and possibly increased cerebral oxygen metabolism. CI - (c) 2023 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd. FAU - Jock, Anna AU - Jock A AUID- ORCID: 0000-0001-5094-6484 AD - Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany. FAU - Neunhoeffer, Felix AU - Neunhoeffer F AD - Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany. FAU - Rorden, Alisa AU - Rorden A AD - Department of Dermatology, University Hospital, Tuebingen, Germany. FAU - Schuhmann, Martin U AU - Schuhmann MU AD - Department of Pediatric Neurosurgery, University Hospital, Tuebingen, Germany. FAU - Zipfel, Julian AU - Zipfel J AUID- ORCID: 0000-0003-4725-713X AD - Department of Pediatric Neurosurgery, University Hospital, Tuebingen, Germany. FAU - Hofbeck, Michael AU - Hofbeck M AD - Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany. FAU - Dietzel, Markus AU - Dietzel M AD - Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany. FAU - Scherer, Simon AU - Scherer S AD - Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany. FAU - Urla, Cristian AU - Urla C AD - Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany. FAU - Fuchs, Jorg AU - Fuchs J AD - Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany. FAU - Michel, Jorg AU - Michel J AUID- ORCID: 0000-0001-8376-4724 AD - Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany. FAU - Fideler, Frank AU - Fideler F AUID- ORCID: 0000-0002-8667-8992 AD - Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tuebingen, Germany. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20231107 PL - France TA - Paediatr Anaesth JT - Paediatric anaesthesia JID - 9206575 RN - S88TT14065 (Oxygen) SB - IM MH - Infant MH - Infant, Newborn MH - Child MH - Humans MH - Prospective Studies MH - Pilot Projects MH - *Oxygen MH - *Heart Defects, Congenital/surgery MH - Brain/metabolism MH - Cerebrovascular Circulation/physiology OTO - NOTNLM OT - brain OT - laser Doppler flowmetry OT - oxygen OT - pediatric surgery OT - postoperative EDAT- 2023/11/07 06:45 MHDA- 2024/01/04 11:44 CRDT- 2023/11/07 05:29 PHST- 2023/10/16 00:00 [revised] PHST- 2023/04/24 00:00 [received] PHST- 2023/10/17 00:00 [accepted] PHST- 2024/01/04 11:44 [medline] PHST- 2023/11/07 06:45 [pubmed] PHST- 2023/11/07 05:29 [entrez] AID - 10.1111/pan.14789 [doi] PST - ppublish SO - Paediatr Anaesth. 2024 Feb;34(2):138-144. doi: 10.1111/pan.14789. Epub 2023 Nov 7.