Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery
(2021) In Paediatric Anaesthesia 31(5). p.563-569- Abstract
Background: Data on cerebral pressure-flow autoregulation in the youngest children are scarce. We studied the correlation between mean arterial pressure and cerebral tissue oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) in patients undergoing nose, lip, and palate surgery. Aim: We tested the hypothesis that cerebral pressure-flow autoregulation is impaired in children less than 1 year undergoing surgery and general anesthesia with sevoflurane under controlled mechanical ventilation. Method: After approval from the Ethical board, 15 children aged <1 year were included. Before anesthesia induction, a NIRS sensor (INVOSTM, Medtronic, Minneapolis, USA) was placed over the cerebral frontal lobe.... (More)
Background: Data on cerebral pressure-flow autoregulation in the youngest children are scarce. We studied the correlation between mean arterial pressure and cerebral tissue oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) in patients undergoing nose, lip, and palate surgery. Aim: We tested the hypothesis that cerebral pressure-flow autoregulation is impaired in children less than 1 year undergoing surgery and general anesthesia with sevoflurane under controlled mechanical ventilation. Method: After approval from the Ethical board, 15 children aged <1 year were included. Before anesthesia induction, a NIRS sensor (INVOSTM, Medtronic, Minneapolis, USA) was placed over the cerebral frontal lobe. Frontal rSO2, a surrogate for cerebral perfusion, mean arterial pressure, end-tidal CO2- and sevoflurane concentration, and arterial oxygen saturation were sampled every minute after the induction. A repeated measures correlation analysis was performed to study correlation between mean arterial pressure and cerebral rSO2, and the repeated measures correlation coefficient (rrm) was calculated. Results: Fifteen patients, aged 7.7 ± 1.9 months, were studied. rSO2 showed a positive correlation with mean arterial pressure ([95% CI: 9.0-12.1], P < 0.001) with a moderate to large effect size (rrm = 0.462), indicating an impaired cerebral pressure-flow autoregulation. The slopes of the rSO2-mean arterial pressure correlations were steeper in patients who were hypotensive (mean arterial pressure <50 mm Hg) compared to patients having a mean arterial pressure ≥50 mm Hg, indicating that at lower mean arterial pressure, the cerebral pressure dependence of cerebral oxygenation is even more pronounced. Conclusion: During sevoflurane anesthesia in the youngest pediatric patients, cerebral perfusion is pressure-dependent, suggesting that the efficiency of the cerebral blood flow autoregulation is limited.
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- author
- Jildenstål, Pether LU ; Widarsson Norbeck, Daniel ; Snygg, Johan ; Ricksten, Sven Erik and Lannemyr, Lukas
- organization
- publishing date
- 2021-02-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- anesthetics, cerebral pressure-flow autoregulation, pediatric anesthesia
- in
- Paediatric Anaesthesia
- volume
- 31
- issue
- 5
- pages
- 563 - 569
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:33527559
- scopus:85100885827
- ISSN
- 1155-5645
- DOI
- 10.1111/pan.14146
- language
- English
- LU publication?
- yes
- id
- 5c322c76-89d7-490f-9961-594f43cc0c78
- date added to LUP
- 2021-03-04 13:10:43
- date last changed
- 2024-09-19 17:19:42
@article{5c322c76-89d7-490f-9961-594f43cc0c78, abstract = {{<p>Background: Data on cerebral pressure-flow autoregulation in the youngest children are scarce. We studied the correlation between mean arterial pressure and cerebral tissue oxygen saturation (rSO<sub>2</sub>) by near-infrared spectroscopy (NIRS) in patients undergoing nose, lip, and palate surgery. Aim: We tested the hypothesis that cerebral pressure-flow autoregulation is impaired in children less than 1 year undergoing surgery and general anesthesia with sevoflurane under controlled mechanical ventilation. Method: After approval from the Ethical board, 15 children aged <1 year were included. Before anesthesia induction, a NIRS sensor (INVOS<sup>TM</sup>, Medtronic, Minneapolis, USA) was placed over the cerebral frontal lobe. Frontal rSO<sub>2</sub>, a surrogate for cerebral perfusion, mean arterial pressure, end-tidal CO<sub>2</sub>- and sevoflurane concentration, and arterial oxygen saturation were sampled every minute after the induction. A repeated measures correlation analysis was performed to study correlation between mean arterial pressure and cerebral rSO<sub>2</sub>, and the repeated measures correlation coefficient (r<sub>rm</sub>) was calculated. Results: Fifteen patients, aged 7.7 ± 1.9 months, were studied. rSO<sub>2</sub> showed a positive correlation with mean arterial pressure ([95% CI: 9.0-12.1], P < 0.001) with a moderate to large effect size (r<sub>rm</sub> = 0.462), indicating an impaired cerebral pressure-flow autoregulation. The slopes of the rSO<sub>2</sub>-mean arterial pressure correlations were steeper in patients who were hypotensive (mean arterial pressure <50 mm Hg) compared to patients having a mean arterial pressure ≥50 mm Hg, indicating that at lower mean arterial pressure, the cerebral pressure dependence of cerebral oxygenation is even more pronounced. Conclusion: During sevoflurane anesthesia in the youngest pediatric patients, cerebral perfusion is pressure-dependent, suggesting that the efficiency of the cerebral blood flow autoregulation is limited.</p>}}, author = {{Jildenstål, Pether and Widarsson Norbeck, Daniel and Snygg, Johan and Ricksten, Sven Erik and Lannemyr, Lukas}}, issn = {{1155-5645}}, keywords = {{anesthetics; cerebral pressure-flow autoregulation; pediatric anesthesia}}, language = {{eng}}, month = {{02}}, number = {{5}}, pages = {{563--569}}, publisher = {{Wiley-Blackwell}}, series = {{Paediatric Anaesthesia}}, title = {{Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery}}, url = {{http://dx.doi.org/10.1111/pan.14146}}, doi = {{10.1111/pan.14146}}, volume = {{31}}, year = {{2021}}, }