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 ,Revised 29 January 2009 ,Accepted 10 February 2009.

References 

  1. Pitetti RD, Singh S, Pierce MC. Safe and efficacious use of procedural sedation and analgesia by nonanesthesiologists in a pediatric emergency department. Arch Pediatr Adolesc Med. 2003;157:1090–1096
  2. Burton JH, Harrah JD, Germann CA, et al. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?. Acad Emerg Med. 2006;13:500–504
  3. Miner JR, Heegaard W, Plummer D. End-tidal carbon dioxide monitoring during procedural sedation. Acad Emerg Med. 2002;9:275–280
  4. Cravero JP, Blike GT, Beach M, et al. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics. 2006;118:1087–1096
  5. Malviya S, Voepel-Lewis T, Eldevik OP, et al. Sedation and general anesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth. 2000;84:743–748
  6. Tortoriello TA, Stayer SA, Mott AR, et al. A noninvasive estimation of mixed venous oxygen saturation using near-infrared spectroscopy by cerebral oximetry in pediatric cardiac surgery patients. Pediatr Anesth. 2005;15:495–503
  7. Kim MB, Ward DS, Cartwright CR, et al. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia. J Clin Monit Comput. 2000;16:191–199
  8. Rais Bahrami K, Rivkra O, Short BL. Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephalad catheter. J Perinatol. 2006;26:628–635
  9. Nelson LA, McCann JC, Loepke AW, et al. Development and validation of a multiwavelength spatial domain near-infrared oximeter to detect cerebral hypoxia-ischemia. J Biomed Opt. 2006;11:064022
  10. Abdul-Khaliq H, Troitzsch D, Berger F, et al. Regional transcranial oximetry with near infrared spectroscopy (NIRS) in comparison with measuring oxygen saturation in the jugular bulb in infants and children for monitoring cerebral oxygenation. Biomed Tech (Berl). 2000;45:328–332
  11. Nagdyman N, Ewert P, Peters B, et al. Comparison of different near-infrared spectroscopic cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in children. Paediatr Anaesth. 2008;18:160–166
  12. Samra SK, Dy EA, Welch K, et al. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology. 2000;93:964–970
  13. Dent CL, Spaeth JP, Jones BV, et al. Brain MRI abnormalities following the Norwood procedure using regional cerebral perfusion. J Thorac Cardiovasc Surg. 2006;131:190–197
  14. Lee E, Melnyk D, Kuskowski M, et al. Correlation of cerebral oximetry measurement with carotid artery stump pressures during carotid endarterectomy. Vasc Surg. 2000;34:403–409
  15. Goldman S, Sutter F, Ferdinand F, et al. Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients. Heart Surg Forum. 2004;7:376–381
  16. Yao FSF, Tseng C-C, Ho CYA, et al. Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18:552–558
  17. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007;104:51–58
  18. Casati A, Fanelli G, Pietropaoli P, et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg. 2005;101:740–747
  19. Fenton KM, Freeman K, Glogowski K, et al. The significance of baseline cerebral oxygen saturation in children undergoing congenital heart surgery. Am J Surg. 2005;190:260–263
  20. Mille T, Tachimiri ME, Klersy C, et al. Near infrared spectroscopy monitoring during carotid endarterectomy: which threshold value is critical?. Eur J Vasc Endovasc Surg. 2004;27:646–650
  21. Singer I, Edmonds HL. Tissue oximetry for the diagnosis of neural syncope. PACE. 2000;23(pt II):2006–2009
  22. Langhan ML, Chen L. Continuous ETCO2monitoring in PED's. Pediatr Emerg Care. 2008;24:211–213
  23. Jense HG, Dubin SA, Silverstein PI, et al. Effect of obesity on safe duration of apnea in anesthetized humans. Anesth Analg. 1991;72:89–93
  24. Green SM. Recent advances in procedural sedation and analgesia. Ann Emerg Med. 2007;49:31–36
  25. Deitch K, Chudnofsky CR, Dominici P. The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial. Ann Emerg Med. 2007;49:1–8
  26. Raj A, Bertolone SJ, Mangold S, et al. Assessment of cerebral tissue oxygenation in patients with sickle cell disease: effect of transfusion therapy. J Pediatr Hematol Oncol. 2004;26:279–283
  27. Cote CJ, Wilson S American Academy of Pediatrics, American Academy of Dentistry, and the Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118:2587–2602
  28. Malviya S, Voepel-Lewis T, Tait AR. A comparison of observational and objective measures to differentiate depth of sedation in children from birth to 18 years of age. Anesth Analg. 2006;102:389–394
  29. Newman DH, Azer MM, Pitetti RD, et al. When is a patient safe for discharge after procedural sedation? (the timing of adverse events in 1367 pediatric procedural sedations). Ann Emerg Med. 2003;42:627–635
  30. Valipour A, McGown AD, Makker H, et al. Some factors affecting cerebral tissue saturation during obstructive sleep apnea. Eur Respir J. 2002;20:444–450
  31. Shigekazu S, Noriaki K, Mizuuchi M. The front is as sensitive as fingers to measure the pulse oximetry during general anesthesia. Can J Anesth. 2004;51:432–436
  32. Hoffman EB, Sen PK, Weinberg CR. Within-cluster resampling. Biometrika. 2001;88:1121–1134
  33. Hogan K, Saccheti A, Aman L, et al. The safety of single-physician procedural sedation in the emergency department. Emerg Med J. 2006;23:922–923
  34. Hager H, Reddy D, Mandadi G, et al. Hypercapnia improves tissue oxygenation in morbidly obese surgical patients. Anesth Analg. 2006;103:677–681
  35. Kety S, Schmidt C. The effect of altered tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest. 1948;27:484–492
  36. Ramamurthy C, Tabbutt S, Kurth CD. Effects of inspired hypoxic and hypercapneic gas mixtures on cerebral oxygen saturation in neonates with univentricular heart defects. Anesthesiology. 2002;96:283–288
  37. Rostrup E, Law I, Pott F, et al. Cerebral hemodynamics measured with simultaneous PET and near-infrared spectroscopy in humans. Brain Res. 2002;954:183–193
  38. Fiset P, Paus T, Daloze T, et al. Mechanisms of propofol-induced loss of consciousness in humans: a positron emission tomographic study. J Neurosci. 1999;19:5506–5513
  39. Mikhel'son VA, Prokop'ev GG, Lazarev VV. Effects of ketamine and propofol on oxygen status and blood content of the brain in children. Anesteziol Reanimatol. 2001;(1):4–8
  40. Lovell AT, Owen-Reece H, Elwell CE, et al. Continuous measurement of cerebral oxygenation by near infrared spectroscopy during induction of anesthesia. Anesth Analg. 1999;88:554
  41. Strebel S, Kaufmann M, Maitre L, et al. Effects of ketamine on cerebral blood flow velocity in humans: influence of pretreatment with midazolam or esmolol. Anesthesia. 1995;50:223–228
  42. Burdett MG, Menon DK, Carpenter TA. Visualization of changes in regional cerebral blood flow (rCBF) produced by ketamine using long TE gradient-echo sequences: preliminary results. Magn Reson Imag. 1995;13:549–553
  43. Hans P, Dewandre PY, Brichant JF, et al. Comparative effects of ketamine on bispectral index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia. Br J Anaesth. 2005;94:336–340
  44. Watkin SL, Spencer SA, Dimmock PW, et al. A comparison of pulse oximetry and near infrared spectroscopy (NIRS) in the detection of hypoxemia occurring with pauses in nasal airflow in neonates. J Clin Monit Comput. 1999;15:441–447
  45. Watzman HM, Kurth CD, Montenegro LM, et al. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology. 2000;93:129–133
  46. Wilkins CJ, Moores M, Harming CD. Comparison of pulse oximeters: effects of vasoconstriction and venous engorgement. Br J Anaesth. 1989;62:439–444
  47. Devries JW, Visser GH, Bakker PF. Neuromonitoring in defibrillation threshold testing (A comparison between EEG, near infrared spectroscopy, and jugular oximetry). J Clin Monit. 2004;13:303–307

 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