Vol.:(0123456789) 1 3 Journal of Anesthesia https://doi.org/10.1007/s00540-017-2446-8 CLINICAL REPORT Changes in tissue and cerebral oxygenation following spinal anesthesia in infants: a prospective study Alexander B. Froyshteter 1  · Dmitry Tumin 1,3  · Emmett E. Whitaker 1,2  · David P. Martin 1,2  · Mumin Hakim 1  · Hina Walia 1  · Tarun Bhalla 1,2  · Joseph D. Tobias 1,2 Received: 2 October 2017 / Accepted: 29 December 2017 © Japanese Society of Anesthesiologists 2018 Abstract Use of spinal anesthesia (SA) in children may address concerns about potential neurocognitive efects of general anesthesia. We used near-infrared spectroscopy (NIRS) to assess the efects of SA on cerebral and tissue oxygenation in 19 patients aged 7 ± 3 months. Prior to SA placement, NIRS monitors were placed on the forehead (cerebral) and the thigh (tissue). Intraop- erative cerebral and tissue saturation were 73 ± 7 and 80 ± 11%, respectively, before SA placement. NIRS measurements were monitored every minute for 30 min after SA placement and modeled using mixed-efects linear regression. Regression estimates showed that cerebral saturation remained stable from 67% [95% confdence interval (CI) 63, 71%] after SA place- ment to 68% (95% CI 65, 72%) at the conclusion of monitoring. After SA placement, tissue saturation was elevated compared to baseline values; but further change [from 91% (95% CI 89, 93%) to 93% (95% CI 91, 95%) at the end of monitoring] was clinically non-signifcant. All patients breathed spontaneously on room air without changes in oxygen saturation. Blood pressure and heart rate decreased after SA placement, but no changes in hemodynamic parameters required treatment. These data provide further evidence of the neutral efect of SA on cerebral oxygenation 30 min after block placement. Keywords Non-invasive monitors · Neuraxial anesthesia · Neurodevelopment · Near-infrared spectroscopy Introduction The use of spinal anesthesia (SA) in children may avoid potential adverse efects of general anesthesia (GA) on the developing brain [1–4]. Clinical experience with SA in infants has demonstrated limited efects on hemodynamic function, even in patients with congenital heart disease [4–7]. This may be due to limited reliance on sympathetic function to maintain blood pressure (BP) among neonates and infants [8]. More recently, hypotension was reported to be more common with GA compared to SA in infants [9]. However, alterations in cerebral blood fow using Doppler analysis were found in 12 former preterm infants undergoing SA [10]. The study concluded that SA induced a decrease in cerebral blood fow related to changes in arterial BP without determining if these changes had deleterious consequences. The goal of our prospective study was to investigate the efects of awake SA on cerebral blood fow and, particularly, cerebral and tissue oxygen saturation using near-infrared spectroscopy (NIRS) monitoring. Materials and methods The study was approved by the Institutional Review Board at Nationwide Children’s Hospital (Columbus, OH, USA) and registered at Clinicaltrials.gov (NCT02840253) in July 2016. Following written consent, patients whose parents had consented to awake SA were enrolled between August 2016 and May 2017. The study included the addition of cerebral and tissue oxygenation monitoring but no change in the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00540-017-2446-8) contains supplementary material, which is available to authorized users. * Dmitry Tumin dmitry.tumin@nationwidechildrens.org 1 Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA 2 Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, USA 3 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA