Thursday, June 19, 2014

Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years

Ossam Rhondali et al.

Pediatric Anesthesia

Volume 24, Issue 7, pages 734–740, July 2014

Children younger than 2 years, ASA I or II, scheduled for abdominal or orthopedic surgery were included.
 Induction of anesthesia was started by sevoflurane 6% and maintained with an expired fraction of sevoflurane 3%. Mechanical ventilation was adjusted to maintain an endtidal CO2 around 39 mmHg. Brain oxygenation was assessed measuring regional cerebral saturation of oxygen (rSO2c), measured by NIRS while awake and 15 min after induction, under anesthesia. Mean arterial pressure (MAP) variation was recorded.
Despite a significant decrease of MAP, 1 MAC of sevoflurane induced a significant increase in regional brain oxygenation. But subgroup analysis showed that MAP decrease had a greater impact on brain oxygenation, in children younger than 6 months. 
According to their results, MAP value during anesthesia should not go under 33 mmHg in children ≤6 months and 43 mmHg in children >6 months, as further changes in MAP, PaCO2 or hemoglobin during anesthesia may be poorly tolerated by the brain.

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