Anesthesiology and Surgical Critical Care Department, Clinical University Hospital of Valladolid, Valladolid, Spain; Biomedical Research Group in Critical Care Medicine (BioCritic), Clinical University Hospital of Valladolid, Valladolid, Spain; Department of Anesthesiology, University of Valladolid, Valladolid, Spain.
Anesthesiology and Surgical Critical Care Department, Clinical University Hospital of Valladolid, Valladolid, Spain; Biomedical Research Group in Critical Care Medicine (BioCritic), Clinical University Hospital of Valladolid, Valladolid, Spain.
J Pediatr. 2019 May;208:207-213.e1. doi: 10.1016/j.jpeds.2018.12.047. Epub 2019 Feb 6.
To evaluate if an intraoperative cerebral regional oxygen saturation (crSO) decrease, less pronounced than 20% below baseline (the current threshold believed to be associated with cognitive dysfunction in adults), is associated with negative postoperative behavioral changes (NPOBC) in the pediatric population after noncardiac surgeries.
A prospective observational study was conducted with 198 children aged 2-12 years old scheduled for noncardiac procedures under general anesthesia. Intraoperatively, crSO was monitored with a cerebral oximeter. On postoperative day 7, the Post-Hospital Behavior Questionnaire was used to diagnose NPOBC.
The incidence of NPOBC was 38.8%. Logistic regression analysis revealed that with every 1% reduction of crSO from the baseline value, the odds of developing NPOBC were 1.199 higher. Likewise, preoperative anxiety (OR 2.832, P = .006), duration of surgery (OR 1.026, P < .0001), and being between the ages of 2 and 3 years (OR 2.604, P = .048) were associated with NPOBC incidence. The multivariable logistic regression model receiver operating characteristic curve showed an area under the curve (95% CI) = 0.820 (0.759-0.881).
During noncardiac surgeries in the pediatric population, an intraoperative decrease in crSO less pronounced than 20% from the baseline value is associated with negative postoperative behavior changes on postoperative day 7. The long-term implications remain to be determined, but this supports attention to crSO during noncardiac surgeries.
评估术中脑区域性血氧饱和度（crSO）下降幅度小于基础值的 20%（目前认为这与成人认知功能障碍相关）是否与非心脏手术后儿科患者的负面术后行为改变（NPOBC）相关。
对 198 名 2-12 岁接受全身麻醉下非心脏手术的儿童进行前瞻性观察性研究。术中使用脑氧饱和度仪监测 crSO。术后第 7 天，采用住院后行为问卷诊断 NPOBC。
NPOBC 的发生率为 38.8%。Logistic 回归分析显示，crSO 较基础值每降低 1%，发生 NPOBC 的几率增加 1.199 倍。此外，术前焦虑（OR 2.832，P =.006）、手术持续时间（OR 1.026，P <.0001）和 2-3 岁（OR 2.604，P =.048）与 NPOBC 的发生相关。多变量逻辑回归模型的接收者操作特征曲线下面积（95%CI）为 0.820（0.759-0.881）。
在儿科非心脏手术中，术中 crSO 较基础值下降幅度小于 20%与术后第 7 天的负面术后行为改变相关。长期影响尚待确定，但这支持在非心脏手术中关注 crSO。
