Functional near‐infrared spectroscopy guided mapping of frontal cortex, a novel modality for assessing emergence delirium in children: A prospective observational study

Abstract

IntroductionDespite an 18%–30% prevalence, there is no consensus regarding pathogenesis of emergence delirium after anesthesia in children. Functional near‐infrared spectroscopy (fNIRS) is an optical neuroimaging modality that relies on blood oxygen level‐dependent response, translating to a mean increase in oxyhemoglobin and a decrease in deoxyhemoglobin. We aimed to correlate the emergence delirium in the postoperative period with the changes in the frontal cortex utilizing fNIRS reading primarily and also with blood glucose, serum electrolytes, and preoperative anxiety scores.MethodsA total of 145 ASA I and II children aged 2–5 years, undergoing ocular examination under anesthesia, were recruited by recording the modified Yale Preoperative Anxiety Score after acquiring the Institute Ethics Committee approval and written informed parental consent. Induction and maintenance were done with O2, N2O, and Sevoflurane. The emergence delirium was assessed using the PAED score in the postoperative period. The frontal cortex fNIRS recordings were taken throughout anesthesia.ResultsA total of 59 children (40.7%) had emergence delirium. The ED+ group had a significant activation left superior frontal cortex (t = 2.26E+00; p = .02) and right middle frontal cortex (t = 2.27E+00; p = .02) during induction, significant depression in the left middle frontal (t = −2.22E+00; p = .02), left superior frontal and bilateral medial (t = −3.01E+00; p = .003), right superior frontal and bilateral medial (t = −2.44E+00; p = .015), bilateral medial and superior (t = −3.03E+00; p = .003), and right middle frontal cortex (t = −2.90E+00; p = .004) during the combined phase of maintenance, and significant activation in cortical activity in the left superior frontal cortex (t = 2.01E+00; p = .0047) during the emergence in comparison with the ED‐ group.ConclusionThere is significant difference in the change in oxyhemoglobin concentration during induction, maintenance, and emergence in specific frontal brain regions between children with and without emergence delirium.

Optical Neuroimaging in Delirium

“…Only two published pilot studies have evaluated the use of NIRS in children with emergence delirium (related to anesthesia), but not in ICU delirium or other common hospital-derived subtypes. Their preliminary results reinforce the conceptual innovation of optical imaging in this specific delirium population, given oxygenation deficit differences between children with and without delirium [74,75].…”