PhD Scientific Days 2022

Clinical Medicine VIII.

Multiomdal non-invasive monitoring during pediatric anesthesia

Text of the abstract

Introduction: Multimodal (MM) non-invasive monitoring during anesthesia could increase the safety of pediatric patients. its application in the clinical practice can be difficult because of the different devices and the real-time evaluation of these large amount of data.
Aims: Our main goal was to test an MM monitoring system during pediatric surgeries and to describe the changes of cerebral oxygenation in a pilot group of patients.
Methods: MM monitoring and high-frequency time-series data collection were introduced sequentially from May 2021 in the pediatric surgery unit of 1st Department of Pediatrics, Semmelweis University. The monitoring system includes: (1) a conventional patient monitor (Drager Infinity), (2) anesthesia machine (Drager Perseus), (3) near-infrared spectroscopic (NIRS) device (Invos, Medtronic), (4) hemodynamic monitor (ICON, Ospyka Medical). Real-time synchronization of the high-frequency data was implemented on a dedicated laptop. The preliminary analysis was performed in Python. In our pilot group, we analyzed the surgical data of 18 neonates, where all monitoring data was available in good quality.
Results: Ventilation and patient monitor data was collected from a total of 257 patients, and NIRS and ICON recordings were collected from 62 patients. 34% (87/257) of our patients were under 6kg. The most common types of surgeries were abdominal and urinary tract surgeries. The average body weight of the children in our 18-person pilot study was 3.2 ± 1.3 kg. The median baseline regional cerebral O2 saturation (rSO2) was 75% [min.50; max.91], the lowest nadir rSO2 during anesthesia was 61% [37; 75]. The measured EtCO2 values during nadir rSO2 were typically low (36 mmHg [23; 50]); while peripheral SatO2 stayed in the normal range (95 [90; 100]). Non-invasive blood pressure (BP) values were also in the lower range (syst BP 54 mmHg [37; 77]). 50% (9/18) of the pilot group spent shorter or longer periods of time below 80% of baseline rSO2 during anesthesia, with a median of 17 [1; 129] minutes.
Conclusion: According to the results of the pilot study, critical NIRS values during neonatal anesthesia were not accompanied by extreme changes in routinely monitored physiological parameters. MM monitoring may be useful in pediatric anesthesia care, but its role in clinical decision-making needs to be further investigated.