A Prospective Observational Study of Intraoperative Regional Cerebral Desaturation and Negative Postoperative Behavioural Changes After Non-Cardiac Paediatric Surgery.

BACKGROUND: Negative postoperative behaviour changes (NPOBC) are known to occur after general anaesthesia in children. A significantly increased risk of NPOBC has been reported in children who exhibited a reduction in cerebral regional oxygen saturation (crSO2) of as little as 5% below baseline levels. These results were unexpected, and we therefore aimed to investigate the association between degrees of regional cerebral desaturation and NPOBC after routine surgery in young children. METHODS: In this prospective cohort study, 180 healthy children between 2 and 6 years old undergoing routine surgery were enrolled. The primary outcome was NPOBC, assessed using the Post Hospitalization Behavior Questionnaire (PHBQ), reported by parents and evaluated on Postoperative Day 7. The results were stratified according to decreases in crSO2 from baseline of at least 5, 10, 15 or 20 percentage points sustained for a minimum duration of 2 min. The χ2 or Fisher's exact test was used to analyse differences in categorical variables. Using logistic regression, outcome data were expressed as odds ratios with 95% confidence intervals. RESULTS: The incidence of NPOBC was 13% on Day 7, and 15% on Day 30, respectively. No significant differences were found between children with or without NPOBC for any of the thresholds of crSO2 reduction (≥ 5%: 2 [11%] vs. 2 [1.8%] cases, p = 0.09; ≥ 10%: 1 [5.6%] vs. 2 [1.8%] cases, p = 0.36; ≥ 15% and ≥ 20%: 0 vs. 0 cases). The rate of NPOBC was not associated with intraoperative reduction in crSO2 (OR 1.25, CI 0.71-2.20, p = 0.46). Older age was associated with lower odds of NPOBCs (OR 0.39, CI 0.15-0.99, p = 0.048). Using the area under the curve for quantifying crSO2 changes did not result in a statistically significant correlation between crSO2 and NPBOCs (r = 0.11). CONCLUSION: Regional cerebral desaturation and negative postoperative behaviour may be less common than previously reported in young children undergoing uneventful general anaesthesia. We could not corroborate the strong association between these entities reported previously. Studies investigating the effects of cerebral desaturation on patient-centred outcomes will need large sample sizes. EDITORIAL COMMENT: This prospective observational study describes a low incidence and magnitude of NIRS desaturation in healthy children. In contrast to previous reporting, there was no association with new negative postoperative behaviours in children in this cohort. TRIAL REGISTRATION: ISCRTN11799594.