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Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery
Author(s) -
Jildenstål Pether,
Widarsson Norbeck Daniel,
Snygg Johan,
Ricksten SvenErik,
Lannemyr Lukas
Publication year - 2021
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.14146
Subject(s) - medicine , cerebral autoregulation , anesthesia , cerebral perfusion pressure , mean arterial pressure , cerebral blood flow , sevoflurane , blood pressure , autoregulation , heart rate
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 2 ) 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 TM , Medtronic, Minneapolis, USA) was placed over the cerebral frontal lobe. Frontal rSO 2 , a surrogate for cerebral perfusion, mean arterial pressure, end‐tidal CO 2 ‐ 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 2 , and the repeated measures correlation coefficient (r rm ) was calculated. Results Fifteen patients, aged 7.7 ± 1.9 months, were studied. rSO 2 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 rm = 0.462), indicating an impaired cerebral pressure‐flow autoregulation. The slopes of the rSO 2 ‐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.