• Vanessa A Olbrecht, Justin Skowno, Vanessa Marchesini, Lili Ding, Yifei Jiang, Christopher G Ward, Gaofeng Yu, Huacheng Liu, Bernadette Schurink, Laszlo Vutskits, Jurgen C de Graaff, Francis X McGowan, Britta S von Ungern-Sternberg, Charles Dean Kurth, and Andrew Davidson.
• From the Department of Anesthesiology (V.A.O., Y.J.) and Division of Biostatistics and Epidemiology (L.D.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Anaesthesia, Children's Hospital at Westmead, Sydney, New South Wales, Australia (J.S.); Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia (J.S.); Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia (V.M., B.S., A.D.); Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.G.W., F.X.M., C.D.K.); Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, China (G.Y.); Department of Anesthesiology, Second Affiliated Hospital and Yuying Children's Hospital of Whenzhou Medical University, Wenzhou, Zhejiang, China (H.L.); Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia (B.S., A.D.); Department of Anesthesiology, Pharmacology, and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland (L.V.); Department of Anesthesiology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands (J.C.d.G.); School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia (B.S.v.U.-S.); and Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia (B.S.v.U.-S.).
• Anesthesiology. 2018 Jan 1; 128 (1): 85-96.

BackgroundGeneral anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia-ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants.MethodsThis multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy. We defined events (more than 3 min) for low cerebral oxygenation as mild (60 to 69% or 11 to 20% below baseline), moderate (50 to 59% or 21 to 30% below baseline), or severe (less than 50% or more than 30% below baseline); for low mean arterial pressure as mild (36 to 45 mmHg), moderate (26 to 35 mmHg), or severe (less than 25 mmHg); and low pulse oximetry saturation as mild (80 to 89%), moderate (70 to 79%), or severe (less than 70%).ResultsThe incidences of mild, moderate, and severe low cerebral oxygenation were 43%, 11%, and 2%, respectively; mild, moderate, and severe low mean arterial pressure were 62%, 36%, and 13%, respectively; and mild, moderate, and severe low arterial saturation were 15%, 4%, and 2%, respectively. Severe low oxygen saturation measured by pulse oximetry was associated with mild and moderate cerebral desaturation; American Society of Anesthesiology Physical Status III or IV versus I was associated with moderate cerebral desaturation. Severe low cerebral saturation events were too infrequent to analyze.ConclusionsMild and moderate low cerebral saturation occurred frequently, whereas severe low cerebral saturation was uncommon. Low mean arterial pressure was common and not well associated with low cerebral saturation. Unrecognized severe desaturation lasting 3 min or longer in infants seems unlikely to explain the subsequent development of neurocognitive abnormalities.

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