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

Pradeep Padmanabhan*, John W. Berkenbosch, Doug Lorenz, Mary Clyde Pierce

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)205-213
Number of pages9
JournalAnnals of Emergency Medicine
Volume54
Issue number2
DOIs
StatePublished - Aug 1 2009

ASJC Scopus subject areas

  • Emergency Medicine

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