Potential Relationship between Cerebral Fractional Tissue Oxygen Extraction (FTOE) and the Use of Sedative Agents during the Perioperative Period in Neonates and Infants.

Danguolė Č Rugytė,Loreta Strumylaitė

doi:10.3390/children7110209

Danguolė Č Rugytė, Loreta Strumylaitė

Open Access

https://doi.org/10.3390/children7110209

Copy DOI

Abstract

Fractional tissue oxygen extraction (FTOE) by means of cerebral near-infrared spectroscopy (NIRS) provides information about oxygen uptake in the brain. Experimental animal data suggest that sedative agents decrease cerebral oxygen demand. The aim of the present study was to investigate the association between the cerebral FTOE and the use of pre and intraoperative sedative agents in infants aged 1–90 days. Cerebral NIRS was continuously applied during open major non-cardiac surgery in 46 infants. The main outcomes were the mean intraoperative FTOE and the percentage (%) of time of intraoperative hyperoxiaFTOE relative to the total duration of anesthesia. HyperoxiaFTOE was defined as FTOE ≤ 0.1. Cumulative doses of sedative agents (benzodiazepines and morphine), given up to 24 h preoperatively, correlated with the mean intraoperative FTOE (Spearman’s rho = −0.298, p = 0.0440) and were predictive for the % of time of intraoperative hyperoxiaFTOE (β (95% CI) 47.12 (7.32; 86.92)) when adjusted for the patients’ age, type of surgery, preoperative hemoglobin, intraoperative sevoflurane and fentanyl dose, mean intraoperative arterial blood pressure, and end-tidal CO2 by multivariate 0.75 quantile regression. There was no association with 0.5 quantile regression. We observed the suggestive positive association of decreased fractional cerebral tissue oxygen extraction and the use of sedative agents in neonates and infants undergoing surgery.

Highlights

Major surgery in neonates and infants has been related to worse neurodevelopmental outcomes [1].The definitive causes of this association are not fully determined, but surgical disease, prematurity, and the potential disturbance of normal physiologic parameters are among the leading ones.Painful stimulation accompanies every perioperative period
We aimed to investigate the association between cerebral Fractional tissue oxygen extraction (FTOE) and perioperative clinical variables, including the use of pre- and intraoperatively administered sedative and analgesic agents
Parameters distributed abnormally are presented as median, normally distributed parameters are presented as mean and standard deviation (SD), and categorical and binomial variables are presented as number of patients (%)

Summary

Introduction

Major surgery in neonates and infants has been related to worse neurodevelopmental outcomes [1].The definitive causes of this association are not fully determined, but surgical disease, prematurity, and the potential disturbance of normal physiologic parameters are among the leading ones.Painful stimulation accompanies every perioperative period. Major surgery in neonates and infants has been related to worse neurodevelopmental outcomes [1]. The definitive causes of this association are not fully determined, but surgical disease, prematurity, and the potential disturbance of normal physiologic parameters are among the leading ones. Pain itself has been related to poorer long-term outcomes [2]. Benzodiazepines and opioids are most widely used agents for neonatal and infantile sedation and analgesia [3]. Negative long-term behavioral effects and the growth retardation of certain brain structures have been associated with the use of these agents in very preterm infants [2,4,5]. The effects of sedatives on the central nervous system of neonates and infants are important

Objectives

Methods

Results

Discussion

Conclusion