{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T21:13:13Z","timestamp":1787692393159,"version":"build-2784847793"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T00:00:00Z","timestamp":1699315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cerebral oxygen desaturation during pediatric surgery has been associated with adverse perioperative outcomes. The aim of this pilot study was to analyze the frequency and severity of intraoperative cerebral oxygen desaturations and their impact on postoperative cerebral oxygen metabolism in neonates and infants undergoing pediatric surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a prospective pilot study, intra\u2010 and postoperative regional cerebral oxygen saturation and blood flow were measured noninvasively using a device combining laser Doppler flowmetry and white\u2010light\u2010spectrometry. Thirty\u2010seven consecutive neonates and infants undergoing noncardiac surgery under general anesthesia for more than 30\u2009min and necessity for invasive arterial blood pressure monitoring were included. Patients with pre\u2010known congenital structural heart disease or cerebral disease were excluded. Continuously brain monitor recording was started in sedated patients before induction of anesthesia (preoperative baseline) and was completed 1\u2009h postoperatively in the PICU in sedated, intubated, and mechanically ventilated states at the PICU (postoperative state). Baseline and postoperative state for cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventeen (46%) of the 37 studied neonates and infants suffered from intraoperative periods of regional cerebral oxygen desaturation below 20% of the baseline (event group). Severity of cerebral desaturations was median 4.0%min\/h [range 0.1\u201358.7; interquartile range [IQR] 0.99\u201321.29]. In the event group, the duration of surgery was significantly longer (median 135\u2009min [range 11\u2013260; IQR 113.5\u2013167.0] vs median 46.5\u2009min [range 11\u2013180; IQR 30.5\u2013159.3]; difference of \u221262.94; 95% confidence interval [CI] \u2212105.17 to \u221220.71; <jats:italic>p<\/jats:italic>\u2009=\u2009.021). In the event group, cerebral fractional tissue oxygen extraction (median 0.41 [range 0.20\u20130.55; IQR 0.26\u20130.44] vs. median 0.27 [range 0.11\u20130.41; IQR 0.20\u20130.31]; difference of \u22120.11; 95% CI \u22120.17 to \u22120.05; <jats:italic>p<\/jats:italic>\u2009=\u2009.001) and approximated cerebral metabolic rate of oxygen (median 6.15 arbitrary unit [range 2.69\u201312.07; IQR 5.12\u20137.21] vs. median 4.14\u2009arbitrary unit [range 1.78\u20137.86; IQR 3.82\u20136.31]; difference of \u22121.76; 95% CI \u22123.03 to \u22120.49; <jats:italic>p<\/jats:italic>\u2009=\u2009.009) were significantly higher and the cerebral regional oxygen saturation (median 58.99% [range 44.87\u201379.1; IQR 54.26\u201372.61] vs median 70.94% [range 57.9\u201386.13; IQR 67.07\u201376.59]; difference of 10.01; 95% CI 4.13\u201315.90; <jats:italic>p<\/jats:italic>\u2009=\u2009.002) significantly lower after surgery compared to the nonevent group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The increase of approximated cerebral metabolic rate of oxygen could indicate an elevated oxidative energy metabolism in the \u201cstressed\u201d brain, due to repair processes. The increased cerebral fractional tissue oxygen extraction fits with the decreased NIRS cerebral oxygenation. Our data suggest that an increase in cerebral oxygen metabolism was the cause.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cerebral oxygen desaturation during major surgery in neonates and infants is associated with early postoperative increased cerebral oxygen extraction and possibly increased cerebral oxygen metabolism.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14789","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T10:15:28Z","timestamp":1699352128000},"page":"138-144","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The effect of intraoperative cerebral oxygen desaturations on postoperative cerebral oxygen metabolism in neonates and infants a pilot study"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5094-6484","authenticated-orcid":false,"given":"Anna","family":"Jock","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Neunhoeffer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisa","family":"R\u00f6rden","sequence":"additional","affiliation":[{"name":"Department of Dermatology University Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin U.","family":"Schuhmann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery University Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4725-713X","authenticated-orcid":false,"given":"Julian","family":"Zipfel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery University Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hofbeck","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Dietzel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Scherer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Urla","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8376-4724","authenticated-orcid":false,"given":"J\u00f6rg","family":"Michel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine University Children's Hospital  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8667-8992","authenticated-orcid":false,"given":"Frank","family":"Fideler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine University Hospital  Tuebingen 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