Anesthesia and intraoperative neurophysiological monitoring in children

Abstract

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.

Intraoperative neurophysiological monitoring for the anaesthetist

“…4 Because of the different number of synapses in the monitored nerve tract, the different INM modalities do not share the same sensitivity to anaesthetic agents. The more synapses in the neurological pathway that is being monitored, the more marked the effect on latency and amplitude of the EPs.…”

“…The drastic effect on VEPs renders this modality useless in the presence of halogenated agents. [4][5][6] Isoflurane has the most potent effect, and halothane the least. Some authors believe that sevoflurane and desflurane are as potent as isoflurane during a steady state.…”

“…5 This characteristic makes sevoflurane and desflurane useful during induction (sevoflurane) and maintenance (desflurane) because their concentration may be rapidly adjusted to minimise the effect of monitoring during surgery. 4 The effect on EPs can be apparent at 0.3-0.5 minimum alveolar concentrations (MAC). Because of the insoluble nature of sevoflurane and desflurane, the anaesthetic effect on INM can change rapidly when concentrations are changed.…”

“…Therefore, to preserve neuronal function during INM, a combination of intravenous agents is often employed. 4 Because of the preservation of EPs, even with the use of high-dose opioids, total intravenous anaesthesia (TIVA) is favoured by many centres. 5 …”

“…3 Because of the physiologically sensitive nervous system and different anaesthetic approaches employed in children, paediatric anaesthetic management of patients undergoing INM requires special consideration. 4 Anaesthetic agents also tend to be more potent and to have longer-lasting effects in children. …”