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Neuromonitoring in paediatric anaesthesia.
Andrew Davidson1,2, Justin Skowno3,4
1Department of Anaesthesia, Royal Children's Hospital.
Current Opinion in Anaesthesiology
|March 21, 2019
Summary
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.
