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Neuromonitoring in paediatric anaesthesia
Andrew Davidson1,2, Justin Skowno3,4
1Department of Anaesthesia, Royal Children's Hospital.
Insights
Recent advances in pediatric neuromonitoring show differences in how anesthesia affects infant EEG, requiring separate calibration for depth monitors. Cerebral oxygenation monitoring is improving understanding but lacks outcome data.
Area of Science:
- Anesthesiology
- Pediatric Neurology
- Neuroscience
Background:
- Neuromonitoring techniques are advancing, with research often transitioning from adults to pediatric populations.
- Recent focus on pediatric neuromonitoring includes anesthesia effect and cerebral perfusion/oxygenation.
Purpose of the Study:
- To review recent (2017-2019) pediatric publications on neuromonitoring for anesthesia effect and cerebral oxygenation.
- To highlight advances in understanding brain activity and perfusion during pediatric anesthesia.
Main Methods:
- Review of recent pediatric publications (2017-2019) focusing on electroencephalogram (EEG)-derived depth monitors and optical neuromonitoring.
- Analysis of studies examining anesthesia's impact on infant EEG and cerebral oxygenation levels.
Main Results:
- EEG-derived depth monitors show improved understanding of their performance in infants, revealing fundamental differences in how anesthesia impacts the developing brain compared to adults.
- Cerebral desaturation is uncommon in neonates and infants under general or spinal anesthesia. CO2 levels significantly influence cerebral oxygenation, and impaired cerebral autoregulation is noted in premature infants.
- Nociception monitors are beginning to be studied in children.
Conclusions:
- Anesthesia's impact on infant EEG differs fundamentally from older children, necessitating separate calibration for anesthesia depth monitors.
- The utility of nociception monitors in pediatric anesthesia requires further definition.
- Cerebral oxygenation monitoring enhances understanding of pediatric cerebral perfusion, but evidence of improved patient outcomes is still pending.
Purpose Of Review:
There has been a steady advance in neuromonitoring during anaesthesia. Inevitably much of the research is first done in adults and later in children. This review will focus on the recent paediatric publications (2017-2019) in two areas of neuromonitoring - measuring anaesthesia effect and cerebral perfusion and oxygenation.
Recent Findings:
For EEG-derived depth monitors, the main recent advances have been in better understanding their performance in infants. For the first time, large multichannel EEG studies on infants have focused on understanding the basic principles of how anaesthesia impacts on the EEG of the developing brain in a way different to the older brain. Nociception monitors are beginning to be studied in children. In the area of optical neuromonitoring, studies show that cerebral desaturation during both general and spinal anaesthesia in infants is uncommon in neonates and infants. Further work emphasizes the importance of CO2 levels on cerebral oxygenation, and demonstrates impaired cerebral autoregulation in premature infants undergoing laparotomies.
Summary:
The impact of anaesthesia on the EEG of small infants has some gross similarities to older children but there are fundamental differences, which mandate separate calibration of anaesthesia depth monitors. The role of nociception monitors in children has yet to be defined. Cerebral oxygenation monitoring during paediatric anaesthesia is improving our understanding of cerebral perfusion in this period, but as with almost all monitoring, evidence that its use improves outcome is not yet available.
