Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study.

Background Advances in perioperative pediatric care have resulted in an increased number of procedures requiring anesthesia. During anesthesia and surgery, the patient is subjected to factors that affect the circulatory homeostasis, which can influence oxygenation of the brain. Near-infrared spectroscopy (NIRS) is an easy applicable noninvasive method for monitoring of regional tissue oxygenation (rScO & x2082;%). Alternate placements for NIRS have been investigated; however, no alternative cranial placements have been explored. Aim To evaluate the agreement between frontal and occipital recordings of rScO & x2082;% in infants using INVOS (TM) during surgery and general anesthesia. Method A standard frontal monitoring of rScO & x2082;% with NIRS was compared with occipital rScO & x2082;% measurements in fifteen children at an age <1 year, ASA 1-2, undergoing cleft lip and/or palate surgery during general anesthesia with sevoflurane. An agreement analysis was performed according to Bland and Altman. Results Mean values of frontal and occipital rScO & x2082;% at baseline were largely similar (70.7 +/- 4.77% and 69.40 +/- 5.04%, respectively). In the majority of the patients, the frontal and occipital recordings of rScO(2) changed in parallel. There was a moderate positive correlation between frontal and occipital rScO & x2082;% INVOS (TM) readings (rho[rho]: 0.513, P < .01). The difference between frontal and occipital rScO & x2082; ranged from -31 to 28 with a mean difference (bias) of -0.15%. The 95% limit of agreement was -18.04%-17.74%. The error between frontal and occipital rScO & x2082; recordings was 23%. Conclusion The agreement between frontal and occipital recordings of brain rScO & x2082;% in infants using INVOS (TM) during surgery and general anesthesia was acceptable. In surgical procedures where the frontal region of the head is not available for monitoring, occipital recordings of rScO & x2082;% could be an option for monitoring.