Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 205-213, August 2009

Evaluation of Cerebral Oxygenation During Procedural Sedation in Children Using Near Infrared Spectroscopy

Presented as a poster in the annual Pediatric Academic Societies meeting, May 2008, Honolulu, HI.

  • Pradeep Padmanabhan, MD, MSc

      Affiliations

    • Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Louisville, Louisville, KY
    • Corresponding Author InformationAddress for correspondence: Pradeep Padmanabhan, MD, MSc, Department of Pediatrics/Division of Pediatric Emergency Medicine, Kosair Children's Hospital, University of Louisville, 571 S Floyd Street, Ste 300, Louisville, KY 40202; 502-629-7212, fax 502-629-5991
    • ,
  • John W. Berkenbosch, MD, FRCPC, FCCM, FAAP

      Affiliations

    • Department of Pediatrics, Division of Pediatric Critical Care, University of Louisville, Louisville, KY
    • ,
  • Doug Lorenz, MA

      Affiliations

    • Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
    • ,
  • Mary Clyde Pierce, MD

      Affiliations

    • Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Louisville, Louisville, KY

Received 24 July 2008; received in revised form 26 November 2008 and 29 January 2009; accepted 10 February 2009. published online 16 March 2009.

Study objective

We evaluate the utility of near infrared spectroscopy monitoring and its correlation to conventional respiratory monitors during changes in cardiorespiratory characteristics during pediatric procedural sedation.

Methods

In this prospective observational study of 100 children, cerebral oxygenation (rSO2), pulse oximetry (SpO2), and end-tidal carbon dioxide (etco2) were monitored continuously. Values were manually recorded at least every 3 minutes from baseline until 30 minutes after sedative administration, resulting in 1,515 triplicate (simultaneous near infrared spectroscopy/etco2/SpO2) measurements. Correlations between conventional monitoring characteristics (SpO2 and etco2) and rSO2 were determined, with focus during adverse cardiorespiratory events.

Results

Cerebral oxygenation remained normal in 1,483 of 1,515 measurements (97.9%). rSO2 decreased significantly during 3 of 13 hypoxic events occurring in 13 patients and during 5 of 17 hypercarbic events occurring in 8 patients, with 15 measurements of greater than 20% decrease from baseline. Cerebral oxygenation increased transiently in 88% of children. During 31 cerebral desaturation recordings, 3 hypoxic recordings (9.3%, always in combination with hypercarbia) and 5 hypercarbic recordings (15.6%) were observed, whereas in 23 (74.2%), cardiorespiratory characteristics were unchanged. There was poor correlation between rSO2 and both SpO2 and etco2, with correlation coefficients of 0.05 (95% confidence interval 0.04 to 0.07) and 0.01 (95% confidence interval –0.01 to 0.02), respectively.

Conclusion

Cerebral oxygenation as measured by near infrared spectroscopy demonstrated few significant negative changes during pediatric procedural sedation. Transient cardiorespiratory events seldom altered rSO2, with hypercarbia having a greater effect than hypoxemia. However, cerebral desaturations frequently occurred without associated cardiorespiratory changes.

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 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Steven M. Green, MD

 Author contributions: PP, JWB, and MCP conceived the study and designed the trial. PP collected the data. PP, JWB, DL, and MCP conducted the data analysis and drafted and revised the article. PP takes responsibility for the article as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online March 13, 2009.

 Reprints not available from the author.

 Dr. Pierce is currently affiliated with Northwestern University Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL.

PII: S0196-0644(09)00153-X

doi:10.1016/j.annemergmed.2009.02.009

Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 205-213, August 2009

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