Challenges in Paediatric Neuroanaesthesia
Muhammad Ramadan Seliem Eissa;
Abstract
Summary
T
he perioperative management of pediatric neurosurgical patients presents many challenges to neurosurgeons and anesthesiologists. Many conditions are unique to pediatrics.
Thorough preoperative evaluation and open communication between members of the health care team are important. So a basic understanding of age-dependent variables and the interaction of anesthetic and surgical procedures are essential in minimizing perioperative morbidity and mortality.
Anatomical and physiological variations in paediatric age group as cerebral blood flow and cerebral autoregulation are discussed in this work.
In the paediatric population, cerebral blood flow (CBF) varies with age and As regard to autoregulation, cerebral blood flow (CBF) is autoregulated in response to changes in mean arterial pressure (MAP). Accurate values for autoregulatory ranges in infants and children are currently unavailable, but are probably related to their normal MAP.
Children with intracranial pathology differ from adults in certain ways that may be advantageous. The fontanelles and non-fused sutures, which can separate even in early adolescence, provide protection from gradual changes in intracranial volume resulting in an increased head size prior to a rise in pressure.
As regards the preoperative considerations the evaluation of the paediatric patient must include history and physical examination pertaining to the conditions requiring special anaesthetic considerations. Assessment of neurological status should include evidence of raised ICP, altered sensorium and cranial nerve palsies.
Respiratory and cardiac-related events account for a majority of these complications. However, a major pitfall in the management of infants and children for neurosurgery is the presence of coexisting diseases.
And for induction of anesthesia, the patient’s neurological status and co-existing abnormalities will dictate the appropriate technique and drugs for induction of anesthesia.
The choice of anesthetic agents for maintenance of anesthesia has been shown not to affect the outcome of neurosurgical procedures either TIVA or nitrous oxide with inhalational anesthetic but maintenance of normovolemia should be mandatory through the procedure and Hyperventilation and maximization of venous drainage of the brain by elevating the head can minimize brain swelling.
Optimal intravenous access is mandatory prior to the start of surgery.
We discussed the benefit and risks of hypothermia in neurosurgical procedures and its effect in decrease of cerebral metabloic rate of O2.
T
he perioperative management of pediatric neurosurgical patients presents many challenges to neurosurgeons and anesthesiologists. Many conditions are unique to pediatrics.
Thorough preoperative evaluation and open communication between members of the health care team are important. So a basic understanding of age-dependent variables and the interaction of anesthetic and surgical procedures are essential in minimizing perioperative morbidity and mortality.
Anatomical and physiological variations in paediatric age group as cerebral blood flow and cerebral autoregulation are discussed in this work.
In the paediatric population, cerebral blood flow (CBF) varies with age and As regard to autoregulation, cerebral blood flow (CBF) is autoregulated in response to changes in mean arterial pressure (MAP). Accurate values for autoregulatory ranges in infants and children are currently unavailable, but are probably related to their normal MAP.
Children with intracranial pathology differ from adults in certain ways that may be advantageous. The fontanelles and non-fused sutures, which can separate even in early adolescence, provide protection from gradual changes in intracranial volume resulting in an increased head size prior to a rise in pressure.
As regards the preoperative considerations the evaluation of the paediatric patient must include history and physical examination pertaining to the conditions requiring special anaesthetic considerations. Assessment of neurological status should include evidence of raised ICP, altered sensorium and cranial nerve palsies.
Respiratory and cardiac-related events account for a majority of these complications. However, a major pitfall in the management of infants and children for neurosurgery is the presence of coexisting diseases.
And for induction of anesthesia, the patient’s neurological status and co-existing abnormalities will dictate the appropriate technique and drugs for induction of anesthesia.
The choice of anesthetic agents for maintenance of anesthesia has been shown not to affect the outcome of neurosurgical procedures either TIVA or nitrous oxide with inhalational anesthetic but maintenance of normovolemia should be mandatory through the procedure and Hyperventilation and maximization of venous drainage of the brain by elevating the head can minimize brain swelling.
Optimal intravenous access is mandatory prior to the start of surgery.
We discussed the benefit and risks of hypothermia in neurosurgical procedures and its effect in decrease of cerebral metabloic rate of O2.
Other data
| Title | Challenges in Paediatric Neuroanaesthesia | Other Titles | التحديات التخديرية في عمليات المخ والأعصاب عند الأطفال | Authors | Muhammad Ramadan Seliem Eissa | Issue Date | 2017 |
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