Age-related incidence of desaturation events and the cardiac responses on stroke index, cardiac index, and heart rate measured by continuous bioimpedance noninvasive cardiac output monitoring in infants and children undergoing general anesthesia

Abstract

Study objectiveTo assess the effects of desaturation on stroke index (SI), cardiac index (CI), and heart rate (HR) using the ICON continuous noninvasive cardiac output monitor in children undergoing general anesthesia. DesignRetrospective analysis of a prospectively collected data set. SettingPediatric operating rooms in a tertiary academic medical center. PatientsChildren younger than 20 years who experienced desaturation while undergoing general anesthesia. InterventionAll records were retrospectively searched for desaturation events defined as a recorded Spo2 ≤ 90%. We compared the data from the prior 4 minutes (baseline) with mild, moderate, and severe levels of desaturation. MeasurementsThe relationship between Spo2 and percent change in SI, CI, and HR from baseline was assessed using a generalized linear model with repeated measures and the least-squares method. Main resultsData from 446 patients were reviewed; 38 events were eligible for analysis after exclusions. There were significant decreases in SI at all saturation ranges below 95%: −6.5% (P < .001) for 85%-95%, −8.9% (P = .002) for 71%-84%, and −11% (P < .001) for ≤70%. Based on the result from the regression, Spo2 was associated with change in SI with borderline significance (P = .053) but not that of HR and CI. There was a strong relationship to desaturation events with young age (P < .001), particularly infants younger than 6 months. ConclusionEvents associated with desaturation in children under general anesthesia were significantly associated with decreased SI with a greater effect with lower saturation nadirs. It is unclear if other concurrent events could have also contributed to adverse hemodynamic responses during desaturation. In most children, a compensatory increase in HR generally offsets concurrent decreases in CI. It would appear that bradycardia is a late manifestation of hypoxemia.