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Intraoperative secondary insults during extracranial surgery in children with traumatic brain injury

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Abstract

Purpose

Data on intraoperative secondary insults in pediatric traumatic brain injury (TBI) are limited.

Methods

We examined intraoperative secondary insults during extracranial surgery in children with moderate-severe TBI and polytrauma and their association with postoperative head computed tomography (CT) scans, intracranial pressure (ICP), and therapeutic intensity level (TIL) scores 24 h after surgery. After IRB approval, we reviewed the records of children <18 years with a Glasgow Coma Scale score <13 who underwent extracranial surgery within 72 h of TBI. Definitions of secondary insults were as follows: systemic hypotension (SBP <70 + 2 × age or 90 mmHg), cerebral hypotension (cerebral perfusion pressure <40 mmHg), intracranial hypertension (ICP >20 mmHg), hypoxia (oxygen saturation <90 %), hypercarbia (end-tidal CO2 >45 mmHg), hypocarbia (end-tidal CO2 <30 mmHg without hypotension and in the absence of intracranial hypertension), hyperglycemia (blood glucose >200 mg/dL), hyperthermia (temperature >38 °C), and hypothermia (temperature <35 °C).

Results

Data from 50 surgeries in 42 patients (median age 15.5 years, 25 males) revealed systemic hypotension during 78 %, hypocarbia during 46 %, and hypercarbia during 25 % surgeries. Intracranial hypertension occurred in 64 % and cerebral hypotension in 18 % surgeries with ICP monitoring (11/50). Hyperglycemia occurred during 17 % of the 29 surgeries with glucose monitoring. Cerebral hypotension and hypoxia were associated with postoperative intracranial hypertension (p = 0.02 and 0.03, respectively). We did not observe an association between intraoperative secondary insults and postoperative worsening of head CT scan or TIL score.

Conclusions

Intraoperative secondary insults were common during extracranial surgery in pediatric TBI. Intraoperative cerebral hypotension and hypoxia were associated with postoperative intracranial hypertension. Strategies to prevent secondary insults during extracranial surgery in TBI are needed.

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Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    Yasuki Fujita, Monica S. Vavilala, Sumidtra Prathep, Suchada Prapruettham & Deepak Sharma

  2. University of Kansas, Kansas City, KS, USA

    Nelson N. Algarra

  3. Harborview Medical Center, 325 Ninth Avenue, Box 359724, Seattle, WA, 98104, USA

    Deepak Sharma

Authors
  1. Yasuki Fujita
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  2. Nelson N. Algarra
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  3. Monica S. Vavilala
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  4. Sumidtra Prathep
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  5. Suchada Prapruettham
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  6. Deepak Sharma
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Correspondence to Deepak Sharma.

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Fujita, Y., Algarra, N.N., Vavilala, M.S. et al. Intraoperative secondary insults during extracranial surgery in children with traumatic brain injury. Childs Nerv Syst 30, 1201–1208 (2014). https://doi.org/10.1007/s00381-014-2353-3

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  • DOI: https://doi.org/10.1007/s00381-014-2353-3

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