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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Neurological monitoring for congenital heart surgery
Dean B Andropoulos1, Stephen A Stayer, Laura K Diaz
1Department of Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Departments of Anesthesiology and Pediatrics, Baylor College of Medicine, Houston Texas, Department of Pediatric Cardiac Anesthesiology, Lucile Packard Children's Hospital at Stanford, Department of Anesthesiology, Stanford University School of Medicine, Stanford, California.
Insights
Neurological complications occur in 2-25% of pediatric cardiac surgeries. Multimodal neurological monitoring during congenital heart surgery may improve patient outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Neuroscience
- Anesthesiology
Background:
- Neurological complications after pediatric cardiac surgery affect 2-25% of patients.
- Causes are multifactorial, including brain malformations, hypoxemia, low cardiac output, cardiopulmonary bypass, and circulatory arrest.
Purpose of the Study:
- To review available neurological monitoring devices for pediatric cardiac surgery.
- To discuss the application of these monitors during congenital heart surgery.
- To present evidence supporting multimodal monitoring and a treatment algorithm for improved neurological outcomes.
Main Methods:
- Review of near-infrared cerebral oximetry.
- Review of transcranial Doppler ultrasound.
- Review of electroencephalographic monitoring.
Main Results:
- Neurological monitoring devices are accessible for intraoperative use.
- Multimodal neurological monitoring, combined with a treatment algorithm, shows potential to enhance neurological outcomes.
- An example treatment algorithm is presented.
Conclusions:
- Neurological monitoring is feasible during pediatric cardiac surgery.
- Multimodal monitoring strategies may mitigate neurological complications.
- Implementing a treatment algorithm alongside monitoring can optimize patient care and outcomes.
Abstract:
The incidence of neurological complications after pediatric cardiac surgery ranges from 2% to 25%. The causes are multifactorial and include preoperative brain malformations, perioperative hypoxemia and low cardiac output states, sequelae of cardiopulmonary bypass, and deep hypothermic circulatory arrest. Neurological monitoring devices are readily available and the anesthesiologist can now monitor the brain during pediatric cardiac surgery. In this review we discuss near-infrared cerebral oximetry, transcranial Doppler ultrasound, and electroencephalographic monitors for use during congenital heart surgery. After review of the basic principles of each monitoring modality, we discuss their uses during pediatric heart surgery. We present evidence that multimodal neurological monitoring in conjunction with a treatment algorithm may improve neurological outcome for patients undergoing congenital heart surgery and present one such algorithm.
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