Significant neonatal intraoperative cerebral and renal oxygen desaturation identified with near-infrared spectroscopy

Introduction Near-infrared spectroscopy (NIRS) was used to monitor intraoperative regional oxygen saturation (rSO(2)) during open (Op) and minimally invasive (MI) surgery performed in neonates (N) and children. Materials and methods NIRS sensors were applied to the forehead and flanks for cerebral rSO(2) (C-rSO(2)) and renal rSO(2) (R-rSO(2)), respectively. MI included laparoscopy (La), retroperitoneoscopy (Re) and thoracoscopy (Th). In children, Op and MI were major operations taking at least 3 h (MOp; MMI). Pathological desaturation (PD) was defined as > 20% deterioration in rSO(2). Results Mean ages at surgery were N: 5.2 +/- 8.2 days, MOp: 2.4 +/- 2.9 years, and MMI: 3.8 +/- 4.3 years. Despite significantly shorter operative times in N (169 +/- 94 min; p < 0.0001), PD was significantly worse; PD(C-rSO(2)): N = 14/35 (40.0%) versus MOp = 3/36 (8.3%) and MMI = 7/58 (12.1%); p = 0.0006, and PD(R-rSO(2)): N = 27/35 (77.1%) versus MOp = 6/36 (16.7%) and MMI = 7/58 (12.1%); p < 0.0001, respectively. PD(R-rSO(2)) occurred immediately with visceral reduction in NOp (Fig. 1) and PD was frequent during NMI(Th) (Fig. 2). rSO(2) was stable throughout MOp and MMI (Fig. 3). Conclusions IRS is a non-invasive technique for monitoring rSO(2) as an indicator of intraoperative stress and vascular perfusion. PD was so significant in neonates that intraoperative NIRS is highly recommended during thoracoscopy and procedures requiring visceral manipulation.