Multimodal Neuromonitoring During Pediatric Cardiac Surgery

Neuromonitoring (electroencephalogram [EEG] and cerebral oximetry) is essential for appropriate anesthesia and neuroprotection assessment during pediatric cardiac surgery.

We describe the intraoperative pediatric multimodal and multiparametric neuromonitoring pattern of the software system Neuron-Spectrum (Kandel®) that consists of continuous electroencephalogram (cEEG), spectral analysis, amplitude-integrated electroencephalogram (aEEG), depth of anesthesia monitor (NINDEX), and regional cerebral and somatic oximetry (near-infrared spectroscopy-INVOS™). A physiological algorithm for management using neuromonitoring and physiological data is also described.

Visual data examples are presented for interpretation of the cerebral perfusion and oxygenation, neurophysiological state, anesthesia depth, possible neurologic predictions, and identification of cerebral drug effects (EEG signature). Conclusion: The neuromonitoring model can be an effective tool for anesthesia control and to provide adequate cerebral oxygenation during surgery.