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Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery

Jildenstål, Pether LU ; Widarsson Norbeck, Daniel ; Snygg, Johan ; Ricksten, Sven Erik and Lannemyr, Lukas (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
; ; ; and
organization
publishing date
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
2024-06-13 08:03:40
@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 &lt;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 &lt; 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 &lt;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}},
}