Changes in tissue and cerebral oxygenation following spinal anesthesia in infants: a prospective study
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Use of spinal anesthesia (SA) in children may address concerns about potential neurocognitive effects of general anesthesia. We used near-infrared spectroscopy (NIRS) to assess the effects of SA on cerebral and tissue oxygenation in 19 patients aged 7 ± 3 months. Prior to SA placement, NIRS monitors were placed on the forehead (cerebral) and the thigh (tissue). Intraoperative cerebral and tissue saturation were 73 ± 7 and 80 ± 11%, respectively, before SA placement. NIRS measurements were monitored every minute for 30 min after SA placement and modeled using mixed-effects linear regression. Regression estimates showed that cerebral saturation remained stable from 67% [95% confidence interval (CI) 63, 71%] after SA placement to 68% (95% CI 65, 72%) at the conclusion of monitoring. After SA placement, tissue saturation was elevated compared to baseline values; but further change [from 91% (95% CI 89, 93%) to 93% (95% CI 91, 95%) at the end of monitoring] was clinically non-significant. All patients breathed spontaneously on room air without changes in oxygen saturation. Blood pressure and heart rate decreased after SA placement, but no changes in hemodynamic parameters required treatment. These data provide further evidence of the neutral effect of SA on cerebral oxygenation 30 min after block placement.
KeywordsNon-invasive monitors Neuraxial anesthesia Neurodevelopment Near-infrared spectroscopy
Compliance with ethical standards
Institutional Review Board approval at Nationwide Children’s Hospital (Columbus, OH, USA) number IRB16-00465 obtained on June 17, 2016.
Conflict of interest
The authors have no conflict of interest to report.
- 4.Davidson AJ, Morton NS, Arnup SJ, de Graaff JC, Disma N, Withington DE, Frawley G, Hunt RW, Hardy P, Khotcholava M, von Ungern Sternberg BS, Wilton N, Tuo P, SalvoI I, Ormond G, Stargatt R, Locatelli BG, McCann ME, The GAS Consortium. Apnea after awake-regional and general anesthesia in infants: The General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnea and neurodevelopmental outcomes, a randomized controlled trial. Anesthesiology. 2015;123:38–54.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.McCann ME, Withington DE, Arnup SJ, Davidson AJ, Disma N, Frawley G, Morton NS, Bell G, Hunt RW, Bellinger DC, Polaner DM, Leo A, Absalom AR, von Ungern-Sternberg BS, Izzo F, Szmuk P, Young V, Soriano SG, de Graaff JC; GAS Consortium. Differences in blood pressure in infants after general anesthesia compared to awake regional anesthesia (GAS study−a prospective randomized trial). Anesth Analg. 2017;125(3):837–45.CrossRefPubMedGoogle Scholar
- 21.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 Jr, von Ungern-Sternberg BS, Kurth CD, Davidson A. An international, multicenter, observational study of cerebral oxygenation during infant and neonatal anesthesia. Anesthesiology 2018;128:85–96.CrossRefPubMedGoogle Scholar