1122 | wileyonlinelibrary.com/journal/pan Pediatric Anesthesia. 2019;29:1122–1127. © 2019 John Wiley & Sons Ltd Received: 3 May 2019 | Revised: 26 August 2019 | Accepted: 14 September 2019 DOI: 10.1111/pan.13743 RESEARCH REPORT Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study Pether Jildenstål 1,2,3 | Johan Sandin 4 | Margareta WarrènStomberg 1 | Jan Pålsson 2,3 | Sven‐Erik Ricksten 2,3 | Johan Snygg 2,3 1 Institute of Health and Care Sciences, Sahlgrenska academy, University of Gothenburg, Gothenburg, Sweden 2 Department of Anesthesia and Intensive Care, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3 Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden 4 Department of children´s surgery division, Queen Silvia´s children´s hospital, Gothenburg, Sweden Correspondence Pether Jildenstål, Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe, Box 457, SE 40530 Gothenburg, Sweden. Email: pether.jildenstal@gu.se Section Editor: Laszlo Vutskits Abstract Background: Advances in perioperative pediatric care have resulted in an increased number of procedures requiring anesthesia. During anesthesia and surgery, the patient is subjected to factors that affect the circulatory homeostasis, which can influence oxygenation of the brain. Near‐infrared spectroscopy (NIRS) is an easy ap‐ plicable noninvasive method for monitoring of regional tissue oxygenation (rScO₂%). Alternate placements for NIRS have been investigated; however, no alternative cra‐ nial placements have been explored. Aim: To evaluate the agreement between frontal and occipital recordings of rScO₂% in infants using INVOS TM during surgery and general anesthesia. Method: A standard frontal monitoring of rScO₂% with NIRS was compared with occipital rScO₂% measurements in fifteen children at an age <1 year, ASA 1‐2, under‐ going cleft lip and/or palate surgery during general anesthesia with sevoflurane. An agreement analysis was performed according to Bland and Altman. Results: Mean values of frontal and occipital rScO₂% at baseline were largely similar (70.7 ± 4.77% and 69.40 ± 5.04%, respectively). In the majority of the patients, the frontal and occipital recordings of rScO 2 changed in parallel. There was a moderate positive correlation between frontal and occipital rScO₂% INVOS™ readings (rho[ρ]: 0.513, P < .01). The difference between frontal and occipital rScO₂ ranged from −31 to 28 with a mean difference (bias) of −0.15%. The 95% limit of agreement was −18.04%‐17.74%. The error between frontal and occipital rScO₂ recordings was 23%. Conclusion: The agreement between frontal and occipital recordings of brain rScO₂% in infants using INVOS TM during surgery and general anesthesia was acceptable. In surgical procedures where the frontal region of the head is not available for monitor‐ ing, occipital recordings of rScO₂% could be an option for monitoring. KEYWORDS Anesthesiology, anesthetics, cerebral oxygenation, Hemodynamics, inhalation, near‐infrared spectroscopy