Emergence cerebral oxygen desaturation without hemodynamic compromise in pediatric patients

The regional cerebral oxygen saturation (rSO(2)) decreases significantly during ordinary anesthetic recovery in pediatric patients anesthetized with sevoflurane or desflurane. The present study examined the relationship between rSO(2) and the clinical parameters associated with the degree of anesthetic recovery.

Twelve pediatric patients with American Society of Anesthesiologists physical status 1 were assigned randomly to receive anesthesia with sevoflurane or desflurane. All children underwent general anesthesia for minor surgery. After surgery, the rSO(2), the age-adjusted MAC fraction of anesthetic concentration (F(E)), and the bispectral index (BIS) were recorded over a 10-minute period. The correlations between rSO(2) and candidate predictors, such as F(E), BIS, anesthetic, and duration of anesthesia, were analyzed.

All children recovered uneventfully. The lowest observed rSO(2) reached 63% and the maximum decrease in rSO(2) was 24%. The mean blood pressure and heart rate were maintained within clinical ranges. The decrease in rSO(2) correlated positively with the F(E) (r = 0.25, P = 0.00) and the duration of anesthesia (r = 0.24, P = 0.01), and inversely with the use of sevoflurane (r = -0.30, P = 0.00).

Despite normal parameters, cerebral desaturation occurred during the emergence of ordinary general anesthesia even without hemodynamic compromise or arterial desaturation. Cerebral desaturation might be associated with the degree of anesthetic recovery and the use of sevoflurane.