Abstract
Background: Induction of anaesthesia with anaesthetic gas might be a potential cause for cerebral impairment in the newborn and young infant. Near infrared spectroscopy - NIRS - is a continuous, non-invasive bedside technique that has been shown to a reliable to monitor cerebral oxygenation status in different conditions. Aim: To assess non-invasively by means of NIRS, cerebral oxygenation during the different steps of induction of anesthesia by sevoflurane. Study population: Children below 2 years of age undergoing elective surgery, without CNS and cardiac malformations were eligible for the study. Three infants aged from 20 to 24 months (20, 22 and 18-month older) have completed the experiment and their data were analysed, so far.
Methods: Induction of anesthesia: under control condition an air oxygen mixture via circle system (face mask connected to a semiclodsed anaesthetic circuit) with an increasing dose (1% - 2% - 3%) of sevoflurane was administered to the child. NIRS was continuously recordedng with a 2-channel instrumentation. Each channel was placed in order to illuminate the tempo-parietal region on each side of the head. After a 60-s baseline (before the exposure to the gas), the stepwise increases of the gas concentration were marked on the NIRS recording. Haemodynamic responses to the different gas concentration have been assessed by NIRS. Oxygenated (O2 Hb), de-oxygenated (H Hb), total haemoglobin (tot Hb) and the derived CBV and TOI have been calculated. Heart rate (HR), blood pressure (BP), peripheral oxygen saturation (satO2) and carbon dioxide (CO2) have been monitored.
Results: In all infants we have observed a clear increase in the cerebral blood volume during the administration of sevoflurane. There was an initial increase in the cerebral tissue oxygenation index. Particularly during step 1 and 2 we have seen a more pronounced increase, while during step 3 the increase was quite slow and not statistically significant. HR, BP and satO2 did not change significantly. CO2 slightly increased, but not significantly.
Conclusion: In the present study, cerebral blood volume increases during the induction of anaesthesia with sevoflurane. Cerebral tissue oxygenation showed a significant increase especially during the first phase of the induction. As approximately 70% of the blood in the cerebral vascular bed is venous blood we can speculate that sevoflure related effect of decreasing venous return may have repercussion on the cerebral blood volume.
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Bartocci, M., Sjögren, D., Lagercrantz, H. et al. 20 Sevoflurane Effect on Cerebral Haemodynamics During Induction of Anesthesia in Young Children Assessed By Near Infrared Spectroscopy. Preliminary Results. Pediatr Res 56, 467 (2004). https://doi.org/10.1203/00006450-200409000-00043
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DOI: https://doi.org/10.1203/00006450-200409000-00043