Age-related incidence of desaturation events and the cardiac responses on stroke index, cardiac index, and heart rate measured by continuous bioimpedance noninvasive cardiac output monitoring in infants and children undergoing general anesthesia.
OBJECTIVE
To assess the effects of desaturation on stroke index (SI), cardiac index (CI), and heart rate (HR) using the ICON continuous noninvasive cardiac output monitor in children undergoing general anesthesia.


METHODS
Retrospective analysis of a prospectively collected data set.


METHODS
Pediatric operating rooms in a tertiary academic medical center.


METHODS
Children younger than 20 years who experienced desaturation while undergoing general anesthesia.


METHODS
All records were retrospectively searched for desaturation events defined as a recorded Spo2 ≤ 90%. We compared the data from the prior 4 minutes (baseline) with mild, moderate, and severe levels of desaturation.


METHODS
The relationship between Spo2 and percent change in SI, CI, and HR from baseline was assessed using a generalized linear model with repeated measures and the least-squares method.


RESULTS
Data from 446 patients were reviewed; 38 events were eligible for analysis after exclusions. There were significant decreases in SI at all saturation ranges below 95%: -6.5% (P < .001) for 85%-95%, -8.9% (P = .002) for 71%-84%, and -11% (P < .001) for ≤70%. Based on the result from the regression, Spo2 was associated with change in SI with borderline significance (P = .053) but not that of HR and CI. There was a strong relationship to desaturation events with young age (P < .001), particularly infants younger than 6 months.


CONCLUSIONS
Events associated with desaturation in children under general anesthesia were significantly associated with decreased SI with a greater effect with lower saturation nadirs. It is unclear if other concurrent events could have also contributed to adverse hemodynamic responses during desaturation. In most children, a compensatory increase in HR generally offsets concurrent decreases in CI. It would appear that bradycardia is a late manifestation of hypoxemia.
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: mrking1@gmail.com.
Michael R
MR
King
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
T Anthony
TA
Anderson
Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Jinghu
J
Sui
Department of Anesthesia, Jiangxi Province General Hospital, Nanchang, China.
Guoluo
G
He
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Kwun Yee T
KY
Poon
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Charles J
CJ
Coté
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000768:Anesthesia, General / Q000009:adverse effects*; D002302:Cardiac Output / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D017097:Electric Impedance; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
Anesthesia, general; Cardiac output; Electric impedance; Hemodynamics; Hypoxemia; Monitoring, physiologic