Measuring Cerebral Carbon Dioxide Reactivity With Transcranial Doppler and Near-Infrared Spectroscopy in Children With Ventricular Septal Defect

Comparison of Inhalational and Intravenous Anesthesia Induction on Electroencephalogram and Cerebral Perfusion in Children With Congenital Heart Disease: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVES

The effects of anesthetics on electroencephalograms and cerebral perfusion remain understudied in children with congenital heart disease. With regard to this, we compared inhalational anesthesia induction and intravenous anesthesia induction.

DESIGN

A randomized controlled trial.

SETTING

Operating room in 2 tertiary hospitals.

PARTICIPANTS

A cohort of 116 pediatrics patients undergoing cardiac surgery.

MEASUREMENTS AND MAIN RESULTS

The patients were randomly assigned to either the intravenous group (n = 58) or the inhalational group (n = 58). The inhalational group received anesthesia induction with 4% to 6% sevoflurane and a bolus of pipecuronium 0.2 mg/kg, whereas the intravenous group received anesthesia induction with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and sufentanil 1 μg/kg. Ten minutes after tracheal intubation, the following parameters were measured: spectral edge frequency, burst suppression event, patient state index, middle cerebral artery blood flow velocity, cerebral oxygen saturation, and hemodynamic parameters. In comparison with the intravenous group, the inhalational group exhibited significant increases in 95% spectral edge frequency, ratio of burst suppression event, blood flow velocity in the middle cerebral artery, and cerebral oxygen saturation (p < 0.05 for all), as well as decreases in systolic pressure, diastolic pressure, cardiac index, and the maximal slope of systolic upstroke (p < 0.05 for all).

CONCLUSIONS

The administration of sevoflurane for anesthesia induction results in more burst suppression, while also demonstrating superior cerebral perfusion when compared with the use of intravenous medications for anesthesia induction.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR1800015946).

The Relationships of Cerebral and Somatic Oxygen Saturation with Physiological Parameters in Pediatric Cardiac Surgery with Cardiopulmonary Bypass: Analysis Using the Random-Effects Model

Recently, tissue oxygenation in pediatric heart surgery is measured by using near-infrared spectroscopy. Monitoring of cerebral oxygen saturation (ScO₂) is most common but that of somatic tissue oxygen saturation (SrO₂) is also gradually becoming widespread. However, the value of their monitoring is not well established. One of the reasons for this may be that the physiological factors affecting ScO₂ and SrO₂ have not been sufficiently clarified. Accordingly, we prospectively observed the changes in ScO₂ and SrO₂ simultaneously throughout cardiac surgery with cardiopulmonary bypass (CPB) in children weighing under 10 kg and evaluated their relationships with physiological parameters by using the random-effects model. ScO₂ and SrO₂ were measured with an INVOS 5100C (Somanetics, Troy, MI, USA). The random-effects analysis was applied for ScO₂ and SrO₂, as dependent variables, and seven physiological parameters (mean blood pressure, central venous pressure, rectal temperature, SaO₂, hematocrit PaCO₂, and pH) were entered as independent covariates. The analysis was performed during the pre-CPB, CPB, and post-CPB periods. Next, the same analysis was performed by dividing the patients into univentricular and biventricular physiological types. Forty-one children were evaluated. Through the whole surgical period, ScO₂ correlated strongly with mean blood pressure regardless of the physiological type. On the other hand, the contribution of mean blood pressure to SrO₂ was weak and various other parameters were related to SrO₂ changes. Thus, the physiological parameters affecting ScO₂ and SrO₂ were rather different. Accordingly, the significance of monitoring of cerebral and somatic tissue oxygen saturation in pediatric cardiac surgery should be further evaluated.