Emergence cerebral oxygen desaturation without hemodynamic compromise in pediatric patients

Abstract

BackgroundThe regional cerebral oxygen saturation (rSO2) decreases significantly during ordinary anesthetic recovery in pediatric patients anesthetized with sevoflurane or desflurane. The present study examined the relationship between rSO2 and the clinical parameters associated with the degree of anesthetic recovery.MethodsTwelve pediatric patients with American Society of Anesthesiologists physical status 1 were assigned randomly to receive anesthesia with sevoflurane or desflurane. All children underwent general anesthesia for minor surgery. After surgery, the rSO2, the age-adjusted MAC fraction of anesthetic concentration (FE), and the bispectral index (BIS) were recorded over a 10-minute period. The correlations between rSO2 and candidate predictors, such as FE, BIS, anesthetic, and duration of anesthesia, were analyzed.ResultsAll children recovered uneventfully. The lowest observed rSO2 reached 63% and the maximum decrease in rSO2 was 24%. The mean blood pressure and heart rate were maintained within clinical ranges. The decrease in rSO2 correlated positively with the FE (r = 0.25, P = 0.00) and the duration of anesthesia (r = 0.24, P = 0.01), and inversely with the use of sevoflurane (r = -0.30, P = 0.00).ConclusionsDespite normal parameters, cerebral desaturation occurred during the emergence of ordinary general anesthesia even without hemodynamic compromise or arterial desaturation. Cerebral desaturation might be associated with the degree of anesthetic recovery and the use of sevoflurane.

Role of hypoxia-inducible factor in postoperative delirium of aged patients: A review

“…[10,11] And more recently, anesthetics and perioperative drugs have been reported to affect HIF-1 activity. [16][17][18][19][20] Research reports that the anesthetics inhibit HIF-1 activation and downstream gene expression. [13][14][15][16][17][18] Hippocampal HIF-1α/vascular endothelial growth factor (VEGF) signaling seems to be the upstream mechanism of isoflurane-induced cognitive impairment and provides a potential preventive and therapeutic target for postoperative delirium.…”

Metabolism of insecticide diazinon by Cunninghamella elegans ATCC36112

“…2 Metabolism studies are very important for the understanding of pesticide toxicity and safety. 14 At present, the research on diazinon metabolism mainly focuses on the metabolites, pathways and related metabolic toxicology of diazinon in mice, dogs and other mammals. [15][16][17] In addition, the metabolism and toxicity of the pesticide in vitro metabolic model (human colon carcinoma cells and human liver microsomes, etc.)…”

Transient decrease of cerebral oxygen saturation during the emergence in children

“…Lee et al [ 1 ] had reported that regional cerebral oxygen saturation (rSO 2 ) decreases neither with an episode of arterial desaturation nor overt hemodynamic compromises during emergence in children. Following their study the authors suggested that the decrease of rSO 2 may correlate inversely with the fraction of anesthetic concentration (F E ) and the duration of anesthesia, and positively with the use of sevoflurane.…”

“…In general, rSO 2 may show upper normal value or higher than the preanesthetic value during general anesthesia because most anesthetics decrease cerebral metabolism (cerebral oxygen demand) while it effects the cerebral blood flow independently. Lee et al [ 1 ] have reported that rSO 2 decreases during emergence in children. Although the decreased rSO 2 result is within normal range in the study, it means as increased cerebral oxygen consumption during emergence.…”