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Updated: Feb 21, 2026
Non-invasive Optical Measurement of Cerebral Metabolism and Hemodynamics in Infants
Published on: March 14, 2013
An International, Multicenter, Observational Study of Cerebral Oxygenation during Infant and Neonatal Anesthesia
Vanessa A Olbrecht1, Justin Skowno, Vanessa Marchesini
1From the Department of Anesthesiology (V.A.O., Y.J.) and Division of Biostatistics and Epidemiology (L.D.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Anaesthesia, Children's Hospital at Westmead, Sydney, New South Wales, Australia (J.S.); Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia (J.S.); Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia (V.M., B.S., A.D.); Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (C.G.W., F.X.M., C.D.K.); Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, China (G.Y.); Department of Anesthesiology, Second Affiliated Hospital and Yuying Children's Hospital of Whenzhou Medical University, Wenzhou, Zhejiang, China (H.L.); Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia (B.S., A.D.); Department of Anesthesiology, Pharmacology, and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland (L.V.); Department of Anesthesiology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands (J.C.d.G.); School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia (B.S.v.U.-S.); and Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Western Australia, Australia (B.S.v.U.-S.).
Insights
Mild and moderate low cerebral oxygenation occurred frequently in infants during general anesthesia, but severe events were rare. These findings suggest that severe desaturation is unlikely to explain neurocognitive abnormalities observed after anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Neurology
- Critical Care Medicine
Background:
- General anesthesia in infants is linked to neurocognitive abnormalities.
- Potential causes include anesthetic neurotoxicity, surgical factors, and reduced cerebral oxygen.
- This study investigated low cerebral oxygenation during infant anesthesia.
Purpose of the Study:
- To determine the incidence of low cerebral oxygenation during general anesthesia in infants.
- To identify factors associated with reduced cerebral oxygenation in this population.
Main Methods:
- A multicenter study involving 453 infants under 6 months undergoing anesthesia.
- Near-infrared spectroscopy measured regional cerebral oxygenation.
- Defined mild, moderate, and severe low cerebral oxygenation, mean arterial pressure, and pulse oximetry saturation.
Main Results:
- Mild (43%) and moderate (11%) low cerebral oxygenation were frequent; severe (2%) was uncommon.
- Low mean arterial pressure was common (mild 62%, moderate 36%, severe 13%).
- Severe low oxygen saturation correlated with mild/moderate cerebral desaturation; ASA Physical Status III/IV associated with moderate desaturation.
Conclusions:
- Mild and moderate cerebral desaturation occurred often, severe events were infrequent.
- Low mean arterial pressure was common but not strongly linked to cerebral desaturation.
- Unrecognized severe desaturation events appear unlikely to cause subsequent neurocognitive issues.
Background:
General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia-ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants.
Methods:
This multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy. We defined events (more than 3 min) for low cerebral oxygenation as mild (60 to 69% or 11 to 20% below baseline), moderate (50 to 59% or 21 to 30% below baseline), or severe (less than 50% or more than 30% below baseline); for low mean arterial pressure as mild (36 to 45 mmHg), moderate (26 to 35 mmHg), or severe (less than 25 mmHg); and low pulse oximetry saturation as mild (80 to 89%), moderate (70 to 79%), or severe (less than 70%).
Results:
The incidences of mild, moderate, and severe low cerebral oxygenation were 43%, 11%, and 2%, respectively; mild, moderate, and severe low mean arterial pressure were 62%, 36%, and 13%, respectively; and mild, moderate, and severe low arterial saturation were 15%, 4%, and 2%, respectively. Severe low oxygen saturation measured by pulse oximetry was associated with mild and moderate cerebral desaturation; American Society of Anesthesiology Physical Status III or IV versus I was associated with moderate cerebral desaturation. Severe low cerebral saturation events were too infrequent to analyze.
Conclusions:
Mild and moderate low cerebral saturation occurred frequently, whereas severe low cerebral saturation was uncommon. Low mean arterial pressure was common and not well associated with low cerebral saturation. Unrecognized severe desaturation lasting 3 min or longer in infants seems unlikely to explain the subsequent development of neurocognitive abnormalities.
