Multimodal Neuromonitoring During Pediatric Cardiac Surgery

Klamt, Jyrson Guilherme; Garcia, Waynice Neiva de Paula; Carvalho, Mariana de; Garcia, Luís Vicente; Menardi, Antônio Carlos

doi:10.21470/1678-9741-2020-0713

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…Multiple reviews have advocated multimodal brain monitoring combining EEG, cerebral oximetry, and transcranial Doppler ultrasound in children undergoing cardiac surgery to improve outcomes. [18][19][20][21] Initiation and separation from CPB are frequently associated with periods of hemodynamic changes or instability, 113 making it challenging to titrate anesthetics to effect. The onset of cooling and hypothermia leads to a reduction of anesthetic requirements 114 ; however, drug pharmacokinetics are also altered due to hemodilution, acid-base changes, and altered metabolism, leading to variable effect.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

“…There were 13 review articles, [12][13][14][15][16][17][18][19][20][21][22][23][24] 10 of which discussed the role and limitations of EEG monitoring during pediatric anesthesia, [12][13][14][15][16][17][18][19][20][21] including 4 relating to cardiac anesthesia. [18][19][20][21] Seven randomized controlled trials investigated EEG-guidance during anesthesia, 11,25,30 several of which demonstrated benefit. 11,[27][28][29] Eight observational studies 9,10,[31][32][33][34][35] demonstrated usefulness of EEG-guided anesthesia in children, and 32 observational studies described anesthesia-induced changes in children's brains.…”

mentioning

confidence: 99%

“…A total of 304 unique articles were screened, 73 underwent full-text review and 59 were included. 11–68 (Supplemental Digital Content 1, Search Strategy, http://links.lww.com/AA/E81.) There were 13 review articles, 12–24 10 of which discussed the role and limitations of EEG monitoring during pediatric anesthesia, 12–21 including 4 relating to cardiac anesthesia.…”

mentioning

confidence: 99%

“…11–68 (Supplemental Digital Content 1, Search Strategy, http://links.lww.com/AA/E81.) There were 13 review articles, 12–24 10 of which discussed the role and limitations of EEG monitoring during pediatric anesthesia, 12–21 including 4 relating to cardiac anesthesia. 18–21 Seven randomized controlled trials investigated EEG-guidance during anesthesia, 11,25,30 several of which demonstrated benefit.…”

mentioning

confidence: 99%

See 3 more Smart Citations

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child’s age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children’s brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children’s EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child’s anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.

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Section: Anesthesia and Analgesiamentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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show abstract

“…The report illustrates that developing a standardized approach to neurophysiologic monitoring is not only feasible, but it is also effective at monitoring cerebral hemodynamics during cardiac surgery. 47,48 Interestingly, this multimodal approach suggests that various neuromonitoring techniques may be complementary rather than exclusive.…”

Section: Introductionmentioning

confidence: 99%

The Year in Review: Anesthesia for Congenital Heart Disease 2022

Goodmanson

Latham

Landsem

et al. 2023

Semin Cardiothorac Vasc Anesth

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This review focuses on the literature published during the calendar year 2022 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease (CHD). Four major themes are discussed: enhanced recovery after surgery(ERAS); diversity, equity, and inclusion; the state of pediatric cardiac anesthesiology as a subspecialty in the United States; and neuromonitoring for pediatric cardiac surgery.

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Alternate Electrode Placements to Facilitate Frontal Electroencephalography Monitoring in Anesthetized and Critically Ill Patients

Isik,

Chauhan,

Ahmed

et al. 2024

Journal of Neurosurgical Anesthesiology

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Background: Frontal electroencephalography (EEG) monitoring can be useful in guiding the titration of anesthetics, but it is not always feasible to place electrodes in the standard configuration in some circumstances, including during neurosurgery. This study compares 5 alternate configurations of the Masimo Sedline Sensor. Methods: Ten stably sedated patients in the intensive care unit were recruited. Frontal EEG was monitored in the standard configuration (bifrontal upright) and 5 alternate configurations: bifrontal inverse, infraorbital, lateral upright, lateral inverse, and semilateral. Average power spectral densities (PSDs) with 95% CIs in the alternate configurations were compared to PSDs in the standard configuration. Two-one-sided-testing with Wilcoxon signed-rank tests assessed equivalence in the spectral edge frequency (SEF-95), EEG power, and relative delta (0.5 to 3.5 Hz), alpha (8 to 12 Hz), and beta (20 to 30 Hz) power between each alternate and standard configurations. Results: After the removal of unanalyzable tracings, 7 patients were included for analysis in the infraorbital configuration and 9 in all other configurations. In the lateral upright and lateral inverse configurations, PSDs significantly differed from the standard configuration within the 15 to 20 Hz band. The greatest decrease in EEG power was in the lateral inverse configuration (median: −97 dB; IQR: −130, −62 dB). The largest change in frequency distribution of EEG power was in the infraorbital configuration; median SEF-95 change of −1.4 Hz (IQR: −2.8, 0.7 Hz), median relative delta power change of +7.3% (IQR: 1.4%, 7.9%), and median relative alpha power change of −0.6% (IQR: −5.7%, 0.0%). Conclusions: These 5 alternate Sedline electrode configurations are suitable options for monitoring frontal EEG when the standard configuration is not possible.

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Multimodal Neuromonitoring During Pediatric Cardiac Surgery

Cited by 4 publications

References 25 publications

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

The Year in Review: Anesthesia for Congenital Heart Disease 2022

Alternate Electrode Placements to Facilitate Frontal Electroencephalography Monitoring in Anesthetized and Critically Ill Patients

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