Effects of Different Measures for the Treatment of Arterial Hypotension on Cerebral Oxygen Saturation During Pediatric General Anesthesia: An Observational Pilot Study

BACKGROUND: Intraoperative hypotension is a common complication in pediatric anesthesia. The definition of hypotension and treatment strategies are heterogeneous. The association of these treatments with cerebral regional oxygen saturation, measured by near-infrared spectroscopy, is insufficiently characterized. AIMS: The study explores whether changes in cerebral regional oxygen saturation, mean arterial pressure, and heart rate differ after the administration of an isotonic fluid bolus, noradrenaline, adrenaline, or cafedrine/theodrenaline for perioperative hypotension in children. METHODS: This single-center, observational pilot study included children aged 18 years or younger undergoing noncardiac surgery who developed hypotension requiring treatment. The choice of the intervention was at the discretion of the attending anesthetist and guided by an internal guideline. Cerebral regional oxygen saturation, mean arterial pressure, and heart rate were recorded for 8 min after the first intervention and analyzed relative to the value immediately before treatment. Groups were compared using the area under the curve of these changes and linear mixed-effects models. RESULTS: Forty-six patients were analyzed. Cerebral regional oxygen saturation immediately before treatment did not differ from the pre-induction baseline. Cafedrine/theodrenaline was the only treatment associated with a sustained increase in cerebral regional oxygen saturation, with a significantly higher area under the curve than noradrenaline (p = 0.017), adrenaline (p = 0.017), and fluid administration (p < 0.001), which was confirmed by mixed-effects models. Only cafedrine/theodrenaline was associated with an increase in heart rate. Changes in heart rate were significantly correlated with changes in cerebral regional oxygen saturation (Spearman's ρ = 0.376, p = 0.010), but not with changes in mean arterial pressure. CONCLUSIONS: Cafedrine/theodrenaline was associated with a sustained increase in cerebral regional oxygen saturation, heart rate, and blood pressure. Noradrenaline, adrenaline, and fluid administration were associated with unchanged or decreasing cerebral regional oxygen saturation. Randomized controlled studies are required to confirm these findings.