{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T23:31:07Z","timestamp":1779319867196,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,6,27]],"date-time":"2016-06-27T00:00:00Z","timestamp":1466985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hypotension (HT) and\/or hypocapnia (<jats:styled-content style=\"fixed-case\">HC<\/jats:styled-content>) are frequent complications occurring during pediatric anesthesia and may cause cerebral injury in the developing brain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of this study is to investigate the effects of <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content> and\/or <jats:styled-content style=\"fixed-case\">HC<\/jats:styled-content> on perfusion and metabolism in the developing brain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010eight piglets were randomly allocated to four groups: control (C), <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> HC<\/jats:styled-content>, and hypotension and hyocapnia (<jats:styled-content style=\"fixed-case\">HTC<\/jats:styled-content>).<\/jats:p><jats:p>Anesthesia was induced and maintained using sevoflurane. Fentanyl was added for instrumentation. Piglets were fully monitored and their lungs were artificially ventilated. Before treatment, conventional magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>), dynamic susceptibility\u2010contrast\u2010enhanced T2*\u2010weighted <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">DSC<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>), and single voxel proton <jats:styled-content style=\"fixed-case\">MR<\/jats:styled-content> spectroscopy (<jats:sup>1<\/jats:sup>H <jats:styled-content style=\"fixed-case\">MRS<\/jats:styled-content>) were performed. Hypotension (mean arterial blood pressure: 30 \u00b1 3 mmHg) was induced by blood withdrawal and nitroprusside infusion, and hyperventilation was used to induce <jats:styled-content style=\"fixed-case\">HC<\/jats:styled-content> (Pa<jats:styled-content style=\"fixed-case\">CO<\/jats:styled-content><jats:sub>2<\/jats:sub>: 2.7\u20133.3 <jats:styled-content style=\"fixed-case\">kP<\/jats:styled-content>a). <jats:sup>1<\/jats:sup>H <jats:styled-content style=\"fixed-case\">MRS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">DSC<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> were repeated immediately once treatment goals were achieved and 120 min later. Radiologists were blinded to the groups. <jats:styled-content style=\"fixed-case\">DSCI<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> and <jats:sup>1<\/jats:sup>H <jats:styled-content style=\"fixed-case\">MRS<\/jats:styled-content> analyses were performed in the thalamus, occipital and parietal lobe, hippocampus, and watershed areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In comparison to C, mean time to peak (<jats:styled-content style=\"fixed-case\">TTP<\/jats:styled-content>) increased with <jats:styled-content style=\"fixed-case\">HTC<\/jats:styled-content> in all brain areas as assessed with <jats:styled-content style=\"fixed-case\">DSC<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> (<jats:italic>n<\/jats:italic> = 26). Using <jats:sup>1<\/jats:sup>H <jats:styled-content style=\"fixed-case\">MRS<\/jats:styled-content>, a significant decrease in <jats:italic>N<\/jats:italic>\u2010acetyl aspartate, choline, and myoinositol, as well as an increase in glutamine\u2013glutamate complex (Glx) were detected independent of group. Compared to C, changes were more pronounced for Glx (due to an increase in glutamate) and myoinositol with <jats:styled-content style=\"fixed-case\">HTC<\/jats:styled-content>, for <jats:italic>N<\/jats:italic>\u2010acetyl aspartate with <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>, and for Glx with <jats:styled-content style=\"fixed-case\">HC<\/jats:styled-content>. No lactate signal was present.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combination of <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HC<\/jats:styled-content> during sevoflurane anesthesia resulted in alteration of cerebral perfusion with signs of neuronal dysfunction and early neuronal ischemia. <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HC<\/jats:styled-content> alone also resulted in signs of metabolic disturbances despite the absence of detectable cerebral perfusion alterations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12956","type":"journal-article","created":{"date-parts":[[2016,6,27]],"date-time":"2016-06-27T12:30:42Z","timestamp":1467030642000},"page":"909-918","source":"Crossref","is-referenced-by-count":17,"title":["Effects of hypotension and\/or hypocapnia during sevoflurane anesthesia on perfusion and metabolites in the developing brain of piglets\u2014a blinded randomized study"],"prefix":"10.1111","volume":"26","author":[{"given":"Simone K.","family":"Ringer","sequence":"first","affiliation":[{"name":"Section Anesthesiology Equine Department Vetsuisse Faculty University of Zurich Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefanie","family":"Ohlerth","sequence":"additional","affiliation":[{"name":"Department for Small Animals Clinic of Diagnostic Imaging Vetsuisse Faculty University of Zurich Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In\u00e9s","family":"Carrera","sequence":"additional","affiliation":[{"name":"Department for Small Animals Clinic of Diagnostic Imaging Vetsuisse Faculty University of Zurich Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Mauch","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Luzerner Kantonsspital Lucerne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelly","family":"Spielmann","sequence":"additional","affiliation":[{"name":"Department of Anesthesia University Children's Hospital Zurich Zurich Switzerland"},{"name":"Children's Research Center University Children's Hospital of Zurich University of Zurich Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regula","family":"Bettschart\u2010Wolfensberger","sequence":"additional","affiliation":[{"name":"Section Anesthesiology Equine Department Vetsuisse Faculty University of Zurich Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Anesthesia University Children's Hospital Zurich Zurich Switzerland"},{"name":"Children's Research Center University Children's Hospital of Zurich University of Zurich Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,6,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2013.10.003"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1102155"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes424"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12310"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(05)70104-4"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.2174\/138945012800675768"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0084622"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0973"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2008.02871.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2009.03140.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12166"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1373.2000.22314.x"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-199106010-00007"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181d8cf2b"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12512"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1042\/CS20140751"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nic.2011.02.007"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-009-1450-z"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000762"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2012.12.020"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31826be417"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-4159.2010.07051.x"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/jcbfm.2014.166"},{"key":"e_1_2_10_25_1","volume-title":"Clinical MR Spectroscopy. Techniques and Applications","author":"Barker PB","year":"2010"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4547(19991115)58:4<576::AID-JNR10>3.0.CO;2-D"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03498.x"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2008.01.027"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet073"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuropharm.2014.03.011"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpan.12956","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.12956","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T11:12:07Z","timestamp":1696245127000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.12956"}},"subtitle":[],"editor":[{"given":"Laszlo","family":"Vutskits","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2016,6,27]]},"references-count":29,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.1111\/pan.12956"],"URL":"https:\/\/doi.org\/10.1111\/pan.12956","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,6,27]]}}}