Cerebral Oxygen Saturation and Negative Postoperative Behavioral Changes in Pediatric Surgery: A Prospective Observational Study

J Pediatr. 2019 May:208:207-213.e1. doi: 10.1016/j.jpeds.2018.12.047. Epub 2019 Feb 6.


Objective: To evaluate if an intraoperative cerebral regional oxygen saturation (crSO2) decrease, less pronounced than 20% below baseline (the current threshold believed to be associated with cognitive dysfunction in adults), is associated with negative postoperative behavioral changes (NPOBC) in the pediatric population after noncardiac surgeries.

Study design: A prospective observational study was conducted with 198 children aged 2-12 years old scheduled for noncardiac procedures under general anesthesia. Intraoperatively, crSO2 was monitored with a cerebral oximeter. On postoperative day 7, the Post-Hospital Behavior Questionnaire was used to diagnose NPOBC.

Results: The incidence of NPOBC was 38.8%. Logistic regression analysis revealed that with every 1% reduction of crSO2 from the baseline value, the odds of developing NPOBC were 1.199 higher. Likewise, preoperative anxiety (OR 2.832, P = .006), duration of surgery (OR 1.026, P < .0001), and being between the ages of 2 and 3 years (OR 2.604, P = .048) were associated with NPOBC incidence. The multivariable logistic regression model receiver operating characteristic curve showed an area under the curve (95% CI) = 0.820 (0.759-0.881).

Conclusions: During noncardiac surgeries in the pediatric population, an intraoperative decrease in crSO2 less pronounced than 20% from the baseline value is associated with negative postoperative behavior changes on postoperative day 7. The long-term implications remain to be determined, but this supports attention to crSO2 during noncardiac surgeries.

Keywords: cerebral oximetry; pediatric anesthesia; postoperative behavioral changes.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Anesthesia, General / adverse effects*
  • Brain / physiopathology*
  • Cerebrovascular Circulation
  • Child
  • Child Behavior Disorders / complications*
  • Child Behavior Disorders / diagnosis
  • Child, Preschool
  • Cross-Sectional Studies
  • Databases, Factual
  • Female
  • Hemodynamics
  • Humans
  • Incidence
  • Male
  • Monitoring, Physiologic / methods
  • Oximetry
  • Oxygen / metabolism*
  • Pediatrics
  • Postoperative Complications / diagnosis*
  • Postoperative Period
  • Prospective Studies
  • Regression Analysis
  • Sensitivity and Specificity
  • Spectroscopy, Near-Infrared


  • Oxygen