title: Developing an objective method for analyzing vital signs changes in neonates during general anesthesia.
abstract: BACKGROUND
  Commonly used general anesthetics are considered to be neurotoxic to the developing rodent brain, leading to poor long-term outcome. However, it is unclear whether these rodent studies can be extrapolated to the human neonate. Given that anesthesia for urgent neonatal surgery cannot be avoided, it is vitally important to assess other factors that may impact neurological outcome following anesthesia and surgery.
  
  
  OBJECTIVE
  The purpose of this study is to identify thresholds for detecting vital sign deviations, which may have the potential for affecting neurological outcome following anesthesia and surgery in neonates. These data may be suitable to identify targets for prospective quality improvement projects and guide future research for strategies to reduce detrimental neurocognitive outcomes.
  
  
  METHODS
  A retrospective analysis of vital sign data was performed for neonates (age ≤28 days), undergoing noncardiac surgery over a 4-year period (2010-2013). Thresholds for detecting bradycardia, tachycardia, hypothermia, hyperthermia, hypertension, hypotension, hypocarbia, hypoxemia, significant changes in mean arterial blood pressure, and periods of high inspired oxygen concentration, were proposed. Selected chart review, to identify additional risk factors, and identify sources of data artifact, was performed for 224 cases.
  
  
  RESULTS
  Data from 435 procedures in neonates, with median (IQR [range]) ages of 6 (2-16 [0-28]) days were available for analysis. Five (3-6 [0-12]) rule deviations per case were observed; only 11 cases had no rule deviations. Hypothermia was observed in 285/435 (70%), moderate hypocapnia in 298/430 (69%), and severe hypotension in 270/435 (62%) cases.
  
  
  CONCLUSIONS
  An objective method of comparing cases has been created with a method to automatically identify neonatal vital sign deviations. With further validation the method has the potential to be a powerful tool to drive future quality improvement projects in neonatal anesthesia.
authors: Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada. mgorges@cw.bc.ca.|Research Institute, BC Children's Hospital, Vancouver, Canada. mgorges@cw.bc.ca.
authors: Matthias
authors: http://orcid.org/0000-0003-2193-178X
authors: M
authors: Görges
authors: Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada.
authors: Nicholas C
authors: NC
authors: West
authors: Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada.
authors: Edda
authors: E
authors: Karlsdóttir
authors: Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada.
authors: J Mark
authors: JM
authors: Ansermino
authors: Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada.
authors: Myles
authors: M
authors: Cassidy
authors: Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada.
authors: Gillian R
authors: GR
authors: Lauder
mesh_terms: D000768:Anesthesia, General; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D055986:Vital Signs / Q000187:drug effects*
keywords: general anesthesia; neonates; severity of illness index; undesirable effects; vital signs