Cerebral Oxygenation, Different Measurement Points and Their Correlation in Pediatric Population
Condition: Anesthesia Complication; Surgical Blood Loss
MeSH terms: Blood Loss, Surgical
Study type: Observational

Summary: 
      Children who undergo surgery routinely for surgery that risk high levels of circulatory
      changes (eg heart surgery) is currently used routinely monitoring as regional oxygenation
      technology of the brain (NIRS). Near infrared spectroscopy (NIRS) is a technique for
      measuring regional oxygen saturation, indirect autoregulation of brain. We know that reduced
      oxygenation of the brain can occur with severe immediate blood loss. We in the research group
      has been able to note that in children who undergo surgery for cranioplasty interventions <1
      year old, when they have ongoing excessive bleeding, decreases oxygenation in the brain and
      sometimes sharply before we can replace the loss of blood, even the blood pressure can be
      adequately maintained. Perioperative hypovolemia is a risk factor upset autoregulation of
      brain. Respect of which the mean arterial pressure (MAP) required to maintain intact
      autoregulation during general anesthesia still lacks a scientific consensus.

      By illuminating the skin and underlying tissue with infrared light in the spectra of 700 to
      1100nm, it is possible to measure regional oxygen saturation in various tissues. At cerebral
      measuring sensor is placed frontally, just below the hairline. INVOS then returns the
      absolute values of cerebral oxygen saturation frontally in the area where the sensor is
      placed.

      A frontal placement may in some cases be impractical / impossible and thus limits the ability
      to monitor the brains of children with different types of surgery or body positions. At
      certain cranioplastic intervention surgery a frontal placement is not always possible, partly
      because of surgical technic reasons, but also that the child may have to lie prone during
      surgery. An alternative placement of INVOS sensor could mean greater opportunities to monitor
      cerebral oxygen saturation and thus increase patient safety within the mentioned categories
      of patients. An occipital location is practically possible in many cases. The purpose of this
      study is to investigate whether a occipital located sensor can measure cerebral oxygen
      saturation in a reliable manner.
    

Detailed description: 
      We want to study patients undergoing cleft lip and palate plastic surgery at Sahlgrenska
      University Hospital. This population has been chosen because it is an age group that is
      homogeneous and suits our aim "two different measuring points (frontal and occipitalt) of
      sensors for regional cerebral oxygenation in children under 1 yrs old, during general
      anesthesia and surgery. We will use a INVOS 5100 (the latest version of INVOS). A sensor will
      be applied, frontally and occipital on the head.

      Patients will be enrolled consecutively when they have been planned for surgery, at
      Salhgrenska University Hospital.

      Perioperative data will be registered in 5-minute intervals from frontally and occipital
      measurements. The measurements begin before the patient is anesthetized and ends when the
      patient is extubated.

      All monitoring data during the general anesthesia will be obtained and documented in a data
      sheet.
    

Intervention name(s): NIRS frontal and occipital
Intervention type(s): Device
Intervention description(s): NIRS frontal and occipital on pediatric population during general anesthesia
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children under one yrs old which shall undergo cleft lip & palate surgery during general
        anesthesia.
      
Keywords: NIRS; Monitoring; Pediatric