The Insight From Foresight: Near-Infrared Spectroscopy in Cyanotic Congenital Heart Disease

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As the attention of pediatric anesthesia providers shifts to neurodevelopment and anesthetic medications, we must remain focused on other potential influences affecting neurologic outcomes following anesthesia and surgery. Tremendous advances in congenital heart surgery and associated reductions in overall mortality afford us the opportunity to focus on neurologic and functional outcomes. Cerebral hypoxia is linked to neurologic injury and worsened neurologic outcomes, especially following pediatric cardiac surgery.1 Lower intraoperative cerebral saturations are correlated with worse neurodevelopmental outcomes in children at 2 years of age.2 In this issue of Anesthesia& Analgesia, Kussman et al3 introduce the important concept that despite chronic hypoxemia in children with cyanotic congenital heart disease, compensatory increases in hemoglobin concentration and cerebral oxygen content serve to maintain normal cerebral oxygen extraction. Comparison of the difference between arterial and jugular bulb measured oxygen content proves to be similar in both chronically cyanotic and acyanotic children. They also report that absolute near-infrared spectroscopy (NIRS) values in children with cyanotic heart disease should fall within the normal range, the implication being that in children with cyanotic heart disease, low NIRS readings, especially in the setting of anemia and/or reduced cardiac output, are a risk factor for neurologic injury.

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