ABSTRACT
BACKGROUND: Spinal Anaesthesia (SA) has been firmly established as an efficient and safe technique, with minimal cardio-respiratory disturbance when administered in the neonatal period. Our objective was to assess the haemodynamic consequences of SA in infants, particularly its impact on cerebral perfusion using near-infrared spectroscopy (NIRS)-based cerebral oximetry (rSco2). METHODS: All infants up to 60 weeks' postmenstrual age, whether formerly preterm or not, and undergoing spinal anaesthesia, were enrolled. Haemodynamic data records, rSco2 and mean arterial blood pressure (MAP), were prospectively collected before SA (T0) and every five min for 30 min (T30) after the puncture. Compared with baseline measures, any changes of > 10% in rSco2 and of > 20% in MAP were considered clinically significant. Relative variations of data between T0 and T30 were analysed. RESULTS: Data of 103 infants were analysed. The mean relative changes in rSco2 were -2.25% (97.5% CI [-3.97; -0.5]) at T15, and 0.11% (97.5% CI [-1.67; 1.90]) at T30. No significant variation of rSco2 was recorded. The mean changes in MAP were respectively -13.94% (97.5% CI [-17.74; -10.14]) at T15 and -20.27% (97.5% CI [-24,25; -16.29]) at T30. MAP decrease was statistically and clinically significant 30 min after SA. No correlation between changes in MAP and rSco2 was found. The subgroup analysis did not reveal any effect of added intrathecal clonidine or preterm birth history on these results. CONCLUSIONS: In neonate and infants, SA did not cause clinically significant variation in cerebral oxygen saturation. Despite a significant decrease in MAP, cerebral auto-regulation seems to remain effective in neonates and not altered by spinal anaesthesia.
Subject(s)
Anesthesia, Spinal , Brain/blood supply , Brain/drug effects , Cerebrovascular Circulation/drug effects , Brain/physiology , Cerebrovascular Circulation/physiology , Female , Hemodynamics/physiology , Humans , Infant , Infant, Newborn , Male , Oximetry/methods , Prospective Studies , Spectroscopy, Near-InfraredABSTRACT
Cerebral oximetry allows continuous real-time and non-invasive monitoring of cerebral oxygen saturation (cSO(2)), by measuring oxyhaemoglobin and deoxyhaemoglobin near infrared light absorption, similarly to pulse oximetry. cSO(2) measurement predominantly reflects brain venous compartment, and is correlated with jugular venous saturation. As jugular venous saturation, cSO(2) must therefore be interpreted as a measure of balance between transport and consumption of O(2) in the brain. Cerebral oximetry should be used as a trend monitoring, because its accuracy is insufficient to be considered as reliable measure of absolute value of ScO(2). In adult, correction of intraoperative cerebral desaturation reduces hospital stay, heavy morbidity and mortality, and serious postoperative neurocognitive impairment after cardiac and major abdominal surgery. In children, the occurrence of intra- and postoperative cerebral desaturations during congenital heart surgery is associated with increased neurological morbi-mortality. Cerebral oximetry could be a useful monitoring during anaesthesia of (ex) preterm neonates, due to the risk of impaired cerebral blood flow autoregulation in these patients.
Subject(s)
Anesthesia , Blood Gas Monitoring, Transcutaneous/methods , Spectroscopy, Near-Infrared/methods , Algorithms , Child , Child, Preschool , Hemoglobinometry , Humans , Infant , Infant, Newborn , Reproducibility of ResultsABSTRACT
Hospitalization at home has known for the past few years a growing interest in care of patients. It has shown its advantages in children in terms of reducing the stress of parental separation, postoperative infections and the cost of hospitalization. But, pain remains the most common complaint in the postoperative follow-up of patients. As in adults, regional anesthesia has also shown interest in children in terms of morphine consumption and quality of postoperative analgesia. However, the use of single shot regional anesthesia seems to induce an exacerbation of pain upon returning home. For management of prolonged postoperative pain at home, continuous peripheral nerve blocks are then presented as the best options. This type of analgesia is mainly reserved for major orthopedic surgery in children. The quality of analgesia obtained in different pediatric studies is excellent with a low rate of adverse events. L-enantiomer local anesthetics are predominantly used at low concentrations for the systemic safety provided. The use of elastomeric disposable pumps for LA infusion allows early and easy ambulation with a simplified management, bringing great satisfaction to parents and children.
Subject(s)
Analgesia/methods , Anesthesia, Conduction/methods , Pain, Postoperative/drug therapy , Anesthetics, Local/administration & dosage , Anesthetics, Local/therapeutic use , Child , Child, Preschool , Home Care Services , Humans , Nerve BlockABSTRACT
INTRODUCTION: Nowadays, the epidemiological data on French pediatric anesthesia is limited. The purpose of this study was to perform an "epidemiological picture" of this activity. MATERIAL AND METHOD: From the national Program Information System Medicalization, we have identified the institutions of France performing more than 50 anesthesia by year in children under 15 years in 2008 and noted the demographic data, types of institutions, hospital stay and surgeries. RESULTS: Seven hundred and eighty-nine thousands and two hundred anesthetic procedures have performed during 648,018 hospital stays in 929 institutions. A percentage of 68.4% of children were between 3 and 15 years old, 26.7% between 1 and 3 years, 4.1% between 1 year and 1 month and 0.8% less than one month, including 62% of boys and 38% of girls. A percentage of 53.6% of hospital stays were realized in private institutions, 20.9% in University Hospitals (UH), and 20.4% in General hospitals (GH), mainly in day-case surgery (60%), 15.2% in stay of 24h and 24.8% in full hospital stay (FHS). The main surgeries were ENT (29%), digestive (21%), orthopedic (14%), urology (12%) and plastics (9%). Children less than 1 year old were managed by University Hospital and during FHS. Older children were managed in private institution and during day-case surgery. CONCLUSION: Over 50% of stays with anesthesia were performed in private institution and during day-case surgery. Controversially, the management of children younger than 1 year was mainly in University Hospital.
