Cerebral Oxygenation during Infant and Neonatal Anesthesia
Does anesthesia in neonatal surgery cause neurological development issues? This has been studied for quite some time and the latest findings still leave the answer ambiguous. A multicenter study led by Vanessa Olbrecht, M.D., M.B.A aimed to shed some light on this imperative question. Though the study didn’t provide a definite answer, it did add a piece to the lasting research puzzle. Let’s take a look at what was discovered.
Potential risk factors of anesthesia during infancy include exposure to toxic substances that disrupt the function of the nervous system, or neurotoxicity, surgical disease, and injury to the brain through lack of oxygen, or cerebral hypoxia-ischemia. These are all mechanisms that can lead to neurocognitive development issues (1). Olbrecht’s study tested 453 infants less than 6 months old who were undergoing general anesthesia for thirty minutes or more. NIRS or near-infrared spectroscopy through Nonin Medical’s SenSmart X-100 system was used to measure cerebral oxygenation.
The study found that mild and moderate low cerebral saturation occurred frequently, but severe desaturation was uncommon. Additionally, low mean arterial pressure although common was not associated with low cerebral saturation. Given this information, how likely is it that unrecognized severe desaturation lasting longer than three minutes can explain subsequent neurodevelopmental issues (1)?
Similar, but not directly related to Olbrecht’s research, George M. Hoffman, MD, and chief of anesthesia at the Children’s Hospital of Wisconsin and Medical College of Wisconsin (Milwaukee) led a study looking to elucidate weather anesthesia in infancy is linked to neurological impairment, or overall mortality. They tested the patient’s physical status prior to surgery and took this into account with their findings.
Hoffman’s team discovered a strong correlation between overall physical health and mortality following multiple prolonged procedures. This information suggests that the anesthesia coupled with the underlying physical condition of the patient, including diseases and physical status can be a foundation for developing neurological impairment (2).
As this issue remains highly controversial, it is important to use reliable devices such as the SenSmart X-100 system to track cerebral oxygenation during anesthesia. This could help lower the risk of hypoxia, and in turn could possibly decrease the outcome of developing neurological impairment. For more information on the Nonin SenSmart X-100 system, visit sensmart.com.
Olbrecht, V.A., Skowno J., Marchesini, V., Ding, L., Jiang, Y., Ward, C.G., … Davidson, A. (2018) An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia. The American Society of Anesthesiologists Inc. Anesthesiology, 128, 85-96. http://anesthesiology.pubs.asahq.org/pdfaccess.ashx?url=/data/journals/jasa/936634/
Vlessides, M. (2018) Risk Factors for Neurodevelopmental Delay in Children Mirror Those for Overall Mortality. Anesthesiology News. Retrieved from https://www.anesthesiologynews.com/Clinical-Anesthesiology/Article/02-18/Risk-Factors-for-Neurodevelopmental-Delay-In-Children-Mirror-Those-for-Overall-Mortality/46815?sub=&enl=true