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.