RESUMO
BACKGROUND: Advances in perioperative pediatric care have resulted in an increased number of procedures requiring anesthesia. During anesthesia and surgery, the patient is subjected to factors that affect the circulatory homeostasis, which can influence oxygenation of the brain. Near-infrared spectroscopy (NIRS) is an easy applicable noninvasive method for monitoring of regional tissue oxygenation (rScO2%). Alternate placements for NIRS have been investigated; however, no alternative cranial placements have been explored. AIM: To evaluate the agreement between frontal and occipital recordings of rScO2% in infants using INVOSTM during surgery and general anesthesia. METHOD: A standard frontal monitoring of rScO2% with NIRS was compared with occipital rScO2% measurements in fifteen children at an age <1 year, ASA 1-2, undergoing cleft lip and/or palate surgery during general anesthesia with sevoflurane. An agreement analysis was performed according to Bland and Altman. RESULTS: Mean values of frontal and occipital rScO2% at baseline were largely similar (70.7 ± 4.77% and 69.40 ± 5.04%, respectively). In the majority of the patients, the frontal and occipital recordings of rScO2 changed in parallel. There was a moderate positive correlation between frontal and occipital rScO2% INVOS™ readings (rho[ρ]: 0.513, P < .01). The difference between frontal and occipital rScO2 ranged from -31 to 28 with a mean difference (bias) of -0.15%. The 95% limit of agreement was -18.04%-17.74%. The error between frontal and occipital rScO2 recordings was 23%. CONCLUSION: The agreement between frontal and occipital recordings of brain rScO2% in infants using INVOSTM during surgery and general anesthesia was acceptable. In surgical procedures where the frontal region of the head is not available for monitoring, occipital recordings of rScO2% could be an option for monitoring.
