{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:07:47Z","timestamp":1785776867100,"version":"3.56.0"},"reference-count":66,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T00:00:00Z","timestamp":1567036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Safeguarding cerebral function is of major importance during pediatric anesthesia. Premature, ex\u2010premature, and full\u2010term neonates can be vulnerable to physiological changes that occur during anesthesia and surgery. Data from studies performed during pediatric cardiac surgery and in neonatal\/pediatric intensive care units have shown the benefits of near\u2010infrared spectroscopy (NIRS) monitoring of regional cerebral oxygenation (c\u2010rSO\n                    <jats:sub>2<\/jats:sub>\n                    ). However, NIRS monitoring is seldom used during noncardiac pediatric anesthesia. Despite compelling evidence that blood pressure does not reflect end\u2010organ perfusion, it is still regarded as the most important determinant of cerebral perfusion and the most relevant hemodynamic management target parameter by most (pediatric) anesthetists. The principle of NIRS monitoring is not self\u2010explanatory and sometimes seems even counterintuitive, which may explain why many anesthesiologists are reserved regarding its use. The first part of this paper is dedicated to a clinical introduction to NIRS monitoring. Despite scientific efforts, it has not yet been possible to define individual lower limit c\u2010rSO\n                    <jats:sub>2<\/jats:sub>\n                    values and it is unlikely this will succeed in the near future. Nonetheless, published treatment algorithms usually specify c\u2010rSO\n                    <jats:sub>2<\/jats:sub>\n                    values which may be associated with cerebral hypoxia. Our treatment guideline for maintaining sufficient cerebral oxygenation differs fundamentally from all previously published approaches. We define a baseline c\u2010rSO\n                    <jats:sub>2<\/jats:sub>\n                    value, registered in the awake child prior to anesthesia induction, as the lowest acceptable limit during anesthesia and surgery. The cerebral rSO\n                    <jats:sub>2<\/jats:sub>\n                    is the single target parameter, while blood pressure, heart rate, P\n                    <jats:sub>a<\/jats:sub>\n                    CO\n                    <jats:sub>2<\/jats:sub>\n                    , and SaO\n                    <jats:sub>2<\/jats:sub>\n                    are major parameters that determine the c\u2010rSO2. Cerebral NIRS monitoring, interpreted together with its continuously available contributing parameters, may help avoid potentially harmful episodes of cerebral desaturation in anesthetized pediatric patients.\n                  <\/jats:p>","DOI":"10.1111\/pan.13726","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T14:26:42Z","timestamp":1566484002000},"page":"993-1001","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["A practical approach to cerebral near\u2010infrared spectroscopy (NIRS) directed hemodynamic management in noncardiac pediatric anesthesia"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6644-3435","authenticated-orcid":false,"given":"Frank","family":"Weber","sequence":"first","affiliation":[{"name":"Department of Anesthesia Erasmus University Medical Center\u2010Sophia Children's Hospital Rotterdam The 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