Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology

Abstract

Purpose of review The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia. Recent findings For cardiac output (CO) monitoring, bolus thermodilution is still considered the gold standard. New noninvasive techniques based on bioimpedance and pulse contour analysis are promising, but require more refining in accuracy of CO values in children. Near-infrared spectroscopy is most commonly used in cardiac surgery despite there being no consensus on safety margins. Its place in noncardiac anesthesia has yet to be determined. Transcutaneous measurements of blood gases are used mainly in the neonatal intensive care unit, and is finding its way to the pediatric operation theatre. Especially CO 2 measurements are accurate and useful. Summary New techniques are available to assess a child's hemodynamic and respiratory status while under anesthesia. These new monitors can be used as complementary tools together with standard monitoring in children, to further improve perioperative safety.

Recent advances in paediatric anaesthesia

“…But these technologies based on adult algorithms will need fine tuning in children before they are accepted in routine practice. [ 6 , 7 ] The transcutaneous measurement of carbon dioxide is complementary to blood sampling and capnography in children and may find a role in procedural sedation monitoring without a definite airway. [ 7 ] Electroencephalography-based anaesthetic depth monitoring is increasingly being used in older children but lacks validity in infants and neonates.…”

“…[ 6 , 7 ] The transcutaneous measurement of carbon dioxide is complementary to blood sampling and capnography in children and may find a role in procedural sedation monitoring without a definite airway. [ 7 ] Electroencephalography-based anaesthetic depth monitoring is increasingly being used in older children but lacks validity in infants and neonates. As per a survey among paediatric anaesthesiologists, the most frequently used depth of anaesthesia monitor was the bispectral index monitor with very few using Entropy, Narcotrend, and the Cerebral State Index.…”

Evaluation of Nociception during Pediatric Surgery: A Topical Review

“…Initially developed to monitor oxygen uptake/consumtpion of the brain, NIRS has been applied to other tissues such as kidney and has been widely used in pediatric open-heart surgery and intensive care [ 14 ]. Functional NIRS (fNIRS) measures changes in the hemoglobin oxygenation (oxygenated and de-oxygenated) as a function of cerebral activity [ 15 ]. The technology has recently been employed to investigate nociception-related brain activity in a number of diseases and conditions [ 16 ].…”

Use of combined cerebral and somatic renal near infrared spectroscopy during noncardiac surgery in children: a proposed algorithm

“…The time has come to tackle these obstacles in order to expand and improve in pediatric anesthesia the use of NIRS monitoring, which is the best presently available monitor of regional tissue perfusion and oxygenation. 32 With an eye to the financial constraints, still limiting the wider adoption of this tool, the top listed points of discussion should include the definition of high risk populations, thus narrowing the target group which may most benefit of it, the focus on neonates, infants, and small children, for whom the existing technology is most appropriate despite its limits, 5,29 the outline of intervention protocols, and the target threshold of saturations and its prognostic value.…”