scholarly journals General Anesthesia Improves Fetal Cerebral Oxygenation without Evidence of Subsequent Neuronal Injury

2005 ◽  
Vol 25 (8) ◽  
pp. 1060-1069 ◽  
Author(s):  
Rebecca J McClaine ◽  
Kenichiro Uemura ◽  
Sebastian G de la Fuente ◽  
Roberto J Manson ◽  
John V Booth ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Fetal Brain ◽  
Drug Regimen ◽  
Initial Increase ◽  
Anesthetic Agents ◽  
Pregnant Sheep ◽  
Near Term ◽  
Anesthetic Exposure

Anesthetic exposure during pregnancy is viewed as a relatively routine medical practice. However, recent rodent studies have suggested that common anesthetic agents can damage the developing brain. Here we assessed this claim in a higher order species by exposing previously instrumented near-term pregnant sheep at gestational day 122 (±1) to a combination of midazolam, sodium thiopental, and isoflurane at clinically relevant doses and means of anesthetic delivery (i.e., active ventilation). Four hours of maternal general anesthesia produced an initial increase in fetal systemic oxygenation and a sustained increase in fetal cerebral oxygenation, as determined by in utero near-infrared spectroscopy. Postexposure monitoring failed to identify changes in physiologic status that could be injurious to the fetal brain. Finally, through the histologic assessment of noninstrumented sheep at the same gestational time point, we found no evidence for a direct fetal neuro-toxic effect of our triple-drug regimen. Collectively, these results appear to corroborate the presumed safety of inhalational anesthetic use during pregnancy.

Cerebral oxygenation changes in response to motor stimulation

1996 ◽  
Vol 81 (3) ◽  
pp. 1174-1183 ◽  
Author(s):  
H. Obrig ◽  
C. Hirth ◽  
J. G. Junge-Hulsing ◽  
C. Doge ◽  
T. Wolf ◽  
...  
Keyword(s):  
Time Course ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Motor Task ◽  
Hemoglobin Concentration ◽  
Hemodynamic Response ◽  
Blood Oxygenation ◽  
Initial Increase ◽  
Cerebral Hemodynamic ◽  
Course Changes

We studied cerebral hemodynamic response to a sequential motor task in 56 subjects to investigate the time course and distribution of blood oxygenation changes as monitored by near-infrared spectroscopy (NIRS). To address whether response is modulated by different performance velocities, a group of subjects (n = 12) was examined while performing the motor task at 1, 2, and 3 Hz. The results demonstrate that 1) the NIRS response reflects localized changes in cerebral hemodynamics, 2) the response, consisting of an increase in oxygenated hemoglobin concentration [oxy-Hb] and a decrease in deoxygenated hemoglobin concentration ([deoxy-Hb]), is lateralized and increases in amplitude with higher performance rates, and 3) changes in [oxy-Hb] and [deoxy-Hb] differ in time course. Changes in [oxy-Hb] are biphasic, with a fast initial increase and a pronounced poststimulus undershoot. The stimulus-associated decrease in [deoxy-Hb] is monophasic, and response latency is greater. We conclude that NIRS is able to detect even small changes in cerebral hemodynamic response to functional stimulation.

Near-infrared spectroscopy in newborns and infants under general anesthesia

2012 ◽  
Vol 19 (3) ◽  
pp. 232-236
Author(s):  
Ilona Šuškevičienė ◽  
Danguolė ČeslavaRugytė ◽  
Tomas Bukauskas ◽  
Alina Vilkė ◽  
Diana Bilskienė ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Infrared Spectroscopy ◽  
General Anesthesia ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Muscle Relaxants ◽  
Cardiovascular Disorders ◽  
Arterial Blood ◽  
Term Newborns

The aim of this study was to find out absolute values of cerebral oxygenation during uncomplicated anesthesia in otherwise healthy newborns and infants undergoing general surgery and to correlate them with demographic and clinical variables. We examined 10 term newborns and infants ASA class I or II without any documented neurological and cardiovascular disorders. All patients underwent general anesthesia with sevoflurane, fentanyl and muscle relaxants. After induction of anesthesia, near-infrared spectroscopy (NIRS) was started and used throughout the surgery. Overall mean (standard deviation (sd)) rSO2 value was 84 ± 8% and weakly correlated with weight (r = 0.5), postnatal age (r = 0.2), SpO2 (r = 0.3) and arterial blood pressure (r = 0.2), p 

Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs

2017 ◽  
Vol 103 (6) ◽  
pp. F530-F538 ◽  
Author(s):  
Graeme R Polglase ◽  
Douglas A Blank ◽  
Samantha K Barton ◽  
Suzanne L Miller ◽  
Vanesa Stojanovska ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Grey Matter ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Cerebrovascular Injury ◽  
Arterial Blood ◽  
Cord Clamping ◽  
Physiologically Based ◽  
Near Term

BackgroundPhysiologically based cord clamping (PBCC) has advantages over immediate cord clamping (ICC) during preterm delivery, but its efficacy in asphyxiated infants is not known. We investigated the physiology of PBCC following perinatal asphyxia in near-term lambs.MethodsNear-term sheep fetuses (139±2 (SD) days’ gestation) were instrumented to measure umbilical, carotid, pulmonary and femoral arterial flows and pressures. Systemic and cerebral oxygenation was recorded using pulse oximetry and near-infrared spectroscopy, respectively. Fetal asphyxia was induced until mean blood pressure reached ~20 mm Hg, where lambs underwent ICC and initiation of ventilation (n=7), or ventilation for 15 min prior to umbilical cord clamping (PBCC; n=8). Cardiovascular parameters were measured and white and grey matter microvascular integrity assessed using qRT-PCR and immunohistochemistry.ResultsPBCC restored oxygenation and cardiac output at the same rate and in a similar fashion to lambs resuscitated following ICC. However, ICC lambs had a rapid and marked overshoot in mean systemic arterial blood pressure from 1 to 10 min after ventilation onset, which was largely absent in PBCC lambs. ICC lambs had increased cerebrovascular injury, as indicated by reduced expression of blood–brain barrier proteins and increased cerebrovascular protein leakage in the subcortical white matter (by 86%) and grey matter (by 47%).ConclusionPBCC restored cardiac output and oxygenation in an identical time frame as ICC, but greatly mitigated the postasphyxia rebound hypertension measured in ICC lambs. This likely protected the asphyxiated brain from cerebrovascular injury. PBCC may be a more suitable option for the resuscitation of the asphyxiated newborn compared with the current standard of ICC.

scholarly journals Excess cerebral oxygen delivery follows return of spontaneous circulation in near-term asphyxiated lambs

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shiraz Badurdeen ◽  
Andrew W. Gill ◽  
Martin Kluckow ◽  
Calum T. Roberts ◽  
Robert Galinsky ◽  
...  
Keyword(s):  
Oxygen Delivery ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Perinatal Asphyxia ◽  
Oxygen Toxicity ◽  
Spontaneous Circulation ◽  
Excess Oxygen ◽  
Cerebral Oxygen ◽  
Return Of Spontaneous Circulation ◽  
Near Term

Abstract Hypoxic-ischaemia renders the neonatal brain susceptible to early secondary injury from oxidative stress and impaired autoregulation. We aimed to describe cerebral oxygen kinetics and haemodynamics immediately following return of spontaneous circulation (ROSC) and evaluate non-invasive parameters to facilitate bedside monitoring. Near-term sheep fetuses [139 ± 2 (SD) days gestation, n = 16] were instrumented to measure carotid artery (CA) flow, pressure, right brachial arterial and jugular venous saturation (SaO2 and SvO2, respectively). Cerebral oxygenation (crSO2) was measured using near-infrared spectroscopy (NIRS). Following induction of severe asphyxia, lambs received cardiopulmonary resuscitation using 100% oxygen until ROSC, with oxygen subsequently weaned according to saturation nomograms as per current guidelines. We found that oxygen consumption did not rise following ROSC, but oxygen delivery was markedly elevated until 15 min after ROSC. CrSO2 and heart rate each correlated with oxygen delivery. SaO2 remained > 90% and was less useful for identifying trends in oxygen delivery. CrSO2 correlated inversely with cerebral fractional oxygen extraction. In conclusion, ROSC from perinatal asphyxia is characterised by excess oxygen delivery that is driven by rapid increases in cerebrovascular pressure, flow, and oxygen saturation, and may be monitored non-invasively. Further work to describe and limit injury mediated by oxygen toxicity following ROSC is warranted.

An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia

2018 ◽  
Vol 128 (1) ◽  
pp. 85-96 ◽  
Author(s):  
Vanessa A. Olbrecht ◽  
Justin Skowno ◽  
Vanessa Marchesini ◽  
Lili Ding ◽  
Yifei Jiang ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pulse Oximetry ◽  
General Anesthesia ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Subsequent Development ◽  
Low Oxygen ◽  
Cerebral Desaturation ◽  
Cerebral Saturation

Abstract Background General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia–ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants. Methods This multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy. We defined events (more than 3 min) for low cerebral oxygenation as mild (60 to 69% or 11 to 20% below baseline), moderate (50 to 59% or 21 to 30% below baseline), or severe (less than 50% or more than 30% below baseline); for low mean arterial pressure as mild (36 to 45 mmHg), moderate (26 to 35 mmHg), or severe (less than 25 mmHg); and low pulse oximetry saturation as mild (80 to 89%), moderate (70 to 79%), or severe (less than 70%). Results The incidences of mild, moderate, and severe low cerebral oxygenation were 43%, 11%, and 2%, respectively; mild, moderate, and severe low mean arterial pressure were 62%, 36%, and 13%, respectively; and mild, moderate, and severe low arterial saturation were 15%, 4%, and 2%, respectively. Severe low oxygen saturation measured by pulse oximetry was associated with mild and moderate cerebral desaturation; American Society of Anesthesiology Physical Status III or IV versus I was associated with moderate cerebral desaturation. Severe low cerebral saturation events were too infrequent to analyze. Conclusions Mild and moderate low cerebral saturation occurred frequently, whereas severe low cerebral saturation was uncommon. Low mean arterial pressure was common and not well associated with low cerebral saturation. Unrecognized severe desaturation lasting 3 min or longer in infants seems unlikely to explain the subsequent development of neurocognitive abnormalities.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

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