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Anesthesia and intraoperative neurophysiological monitoring in children
1Department of Anesthesiology, University of Colorado at Denver and Health Sciences Center, MS 8202, Anschutz Office West (AO1), 12631 E 17th Avenue, PO Box 6511, Aurora, CO 80045, USA. Tod.Sloan@ucdenver.edu
Insights
Pediatric anesthesia for neurophysiological monitoring is similar to adult protocols. While propofol infusion syndrome (PRIS) is a concern, most centers use strategies to mitigate risks rather than avoid propofol entirely.
Area of Science:
- Pediatric Anesthesiology
- Neuroanesthesia
- Intraoperative Neurophysiological Monitoring (IONM)
Background:
- Anesthesia for pediatric surgery with IONM requires understanding anesthetic effects on neural pathways and nutrient supply.
- Pediatric anesthesia differs from adult anesthesia due to unique considerations like propofol infusion syndrome (PRIS) and immature neural pathways.
Purpose of the Study:
- To determine if anesthesia protocols for pediatric patients undergoing surgery with IONM differ from those used in adults.
- To assess concerns regarding propofol infusion syndrome (PRIS) in pediatric anesthesia protocols.
Main Methods:
- A review of anesthetic implications on neural systems was conducted.
- A survey was distributed to pediatric anesthesia practitioners across 40 North American centers.
- Practitioners were asked about their anesthesia protocols for pediatric surgery involving IONM and any modifications due to PRIS concerns.
Main Results:
- Twenty-five centers responded, reporting 35 distinct anesthesia protocols.
- The identified protocols closely resemble those used for adult patients.
- No centers completely avoided propofol; however, strategies to reduce dosage, select patients, or monitor for PRIS were employed.
Conclusions:
- Anesthesia practices for pediatric patients undergoing surgery with IONM align with adult anesthesia principles.
- While PRIS has not significantly altered outcomes for most pediatric patients, awareness has influenced some anesthesiologists' practices.
Purpose:
Anesthesia for pediatric patients undergoing surgery where intraoperative neurophysiological monitoring (IONM) is performed is based on an understanding of the anesthetic influence on the neural pathways involved and the physiology that supplies nutrients to the neural systems. Anesthesia in pediatric patients may be different than in adults due to the specific anesthesia considerations in children, notably the propofol infusion syndrome (PRIS) and the need to monitor immature neural pathways. This review was done to determine if the anesthesia protocols used were different than those used in adults.
Methods:
After reviewing the implications of anesthetic action, a survey of pediatric anesthesia practitioners in 40 North American centers was conducted to determine the anesthesia protocols used in pediatric surgery with IONM and if these were specifically modified over concerns about PRIS.
Results:
Twenty-five centers responded with 35 different protocols used by practitioners. These protocols are similar to protocols used in adult patients. Although no centers specifically avoided propofol in all patients, several strategies were used to reduce the dosage, avoid its use in selected patients, or monitor for the onset of the syndrome.
Conclusion:
Anesthesia for pediatric patients undergoing surgery where IONM is being performed is consistent with the practice and principles of anesthesia for adults. Although PRIS has not caused major alterations in most patients, concern has modified the practice of some anesthesiologists.
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