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PEDIATRIC ANESTHESIA

Neurological Monitoring for Congenital Heart Surgery

Department of Pediatric Cardiovascular Anesthesiology, Texas Children’s Hospital, Departments of Anesthesiology and Pediatrics, Baylor College of Medicine, Houston Texas, Department of Pediatric Cardiac Anesthesiology, Lucile Packard Children’s Hospital at Stanford, Department of Anesthesiology, Stanford University School of Medicine, Stanford, California

Address correspondence to Dean B. Andropoulos, MD, 6621 Fannin WT19345H, Houston TX 77030. Address email to dra{at}bcm.tmc.edu

The incidence of neurological complications after pediatric cardiac surgery ranges from 2% to 25%. The causes are multifactorial and include preoperative brain malformations, perioperative hypoxemia and low cardiac output states, sequelae of cardiopulmonary bypass, and deep hypothermic circulatory arrest. Neurological monitoring devices are readily available and the anesthesiologist can now monitor the brain during pediatric cardiac surgery. In this review we discuss near-infrared cerebral oximetry, transcranial Doppler ultrasound, and electroencephalographic monitors for use during congenital heart surgery. After review of the basic principles of each monitoring modality, we discuss their uses during pediatric heart surgery. We present evidence that multimodal neurological monitoring in conjunction with a treatment algorithm may improve neurological outcome for patients undergoing congenital heart surgery and present one such algorithm.

IMPLICATIONS: Brain monitoring for pediatric cardiac surgery (near infrared cerebral oximetry, transcranial Doppler ultrasound, and processed electroencephalogram) is now readily available and has the potential to improve neurological outcomes.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999