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Effect of Inhaled Sevoflurane on Pediatric Cerebrospinal Fluid Pressure During Lumbar Puncture; Implications for
Shawn C Aylward1, Brandon S Aylward2, Gina M Fedel3
1Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Sevoflurane did not significantly correlate with cerebrospinal fluid pressure changes in children during lumbar puncture. However, assisted ventilation, not sevoflurane levels, impacted pressure, suggesting spontaneous respiration yields more accurate readings.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Neurosurgery
Background:
- Cerebrospinal fluid pressure (CFP) monitoring is crucial in pediatric procedures.
- The influence of anesthetic agents like sevoflurane on CFP requires further elucidation.
- Lumbar puncture procedures in children necessitate careful consideration of physiological parameters.
Purpose of the Study:
- To investigate the impact of sevoflurane on cerebrospinal fluid pressure during pediatric lumbar puncture.
- To identify factors influencing CFP measurements in children undergoing anesthesia.
Main Methods:
- Measurements of CFP, end-tidal carbon dioxide, and end-tidal sevoflurane concentration were taken at 2-minute intervals for 10 minutes.
- Data collection was performed at the conclusion of the lumbar puncture, post-sevoflurane cessation.
- Patient weight status and presence of optic edema were also considered.
Main Results:
- No significant correlation was found between end-tidal sevoflurane concentration and CFP.
- CFP showed an initial increase then decrease as sevoflurane levels dropped.
- Assisted ventilation, unlike sevoflurane, significantly altered CFP, with spontaneous respiration showing more stable pressures.
Conclusions:
- Sevoflurane levels do not appear to directly influence cerebrospinal fluid pressure in this pediatric cohort.
- Assisted ventilation is a significant factor affecting CFP during pediatric lumbar puncture.
- Accurate CFP measurements are best obtained in pediatric patients exhibiting spontaneous respirations.
Abstract:
Objective: To determine influence of sevoflurane on changes in cerebrospinal fluid pressure in children presenting for lumbar puncture. Methods: Cerebrospinal fluid pressure, end tidal carbon dioxide, and end tidal sevoflurane concentration measurements were obtained at 2-minute intervals for a total of 10 minutes (T0 to T5). Because of concerns regarding patient safety and comfort, the study measurements were completed at the end of the lumbar procedure, starting with the closing pressure and when sevoflurane was stopped. Results: As end tidal sevoflurane concentration decreased, cerebrospinal fluid pressure initially increased up to T2 before decreasing back to around the initial point. There was no significant correlation between sevoflurane level and cerebrospinal fluid pressure. Both weight status and presence or absence of optic edema did not have a significant impact on pressure over time. However, there was a statistically significant difference in the cerebrospinal fluid pressure over time between those with spontaneous respirations compared to those without. Conclusions: There was no significant correlation between the end tidal sevoflurane concentration and cerebrospinal fluid pressure. Assisted ventilation did produce a statistically significant increase in cerebrospinal fluid pressure and suggests that the most accurate measurements are in those with spontaneous respirations.
