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Perioperative Care of the Pediatric Neurosurgical Patient

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Pediatric Critical Care Medicine

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Abstract

The management of infants and children with conditions of the brain and spinal cord can be challenging, and optimal management requires a thorough understanding of the developmental stages, age related physiological changes, and the pathophysiological processes that occur with these conditions. Patients with neurological conditions often undergo neurosurgical procedures and encounter clinicians from a variety of specialties. The perioperative period, is therefore, an important therapeutic window and clinicians who manage these patients during this period can provide patients with the opportunity to achieve full neurological recovery before, during, and after neurosurgery. For the preoperative period, pediatricians and emergency physicians are able to diagnose urgent/emergent neurosurgical conditions, prepare patients neurosurgery and prevent clinical deterioration from neurological conditions until definitive therapy such as neurosurgery can be provided. During surgery, anesthesiologists aim to provide optimal brain physiological conditions and optimal anesthetic and hemodynamic care during complex neurosurgical procedures. During the postoperative period, intensivists are responsible for anticipating and preventing postoperative consequences, and for helping patients achieve full neurological recovery. This chapter provides information on the neurological issues that should be considered during the perioperative period in the care of children undergoing neurosurgery.

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Abbreviations

ADH:

Antidiuretic hormone

ATLS:

Advanced Trauma Life Support

ATP:

Adenosine triphosphate

AVM:

Arteriovenous malformations

BBB:

Blood brain barrier

CBF:

Cerebral Blood Flow

CBFV:

Cerebral blood flow velocity\

cCAMP:

Cyclic adenosine monophosphate

cGMP:

Cyclic guanosine monophosphate

CMR:

Cerebral metabolic rate

CMRglu:

Cerebral metabolic rate for glucose

CMRO2 :

Cerebral metabolic rate of oxygen

CNS:

Central Nervous System

CO2 :

Carbon dioxide

CO2R:

Reactivity to Carbon dioxide

CPP:

Cerebral perfusion pressure

CS:

Cortical stimulation

CSF:

Cerebro-spinal fluid

CSW:

Cerebral salt wasting

CT:

Computed tomography

CVR:

Cerebrovascular resistance

DI:

Diabetes insipidus

ECoG:

Electrocorticography

EEG:

Electroencephalogram

EMG:

Electromyography

ET-1:

Endothelin-1

GCS:

Glasgow Coma Scale

HR:

Hoffman reflex

ICP:

Intracranial Pressure

ICPm:

Intracranial Pressure monitoring

IHAST:

International Hypothermia in Aneurysm Surgery Trial \

IM:

Intramuscular

iTBI:

Involving Traumatic Brain Injury

IV:

Intravenous

LLA:

Lower Limit of Autoregulation

MAC:

Minimum alveolar concentration

MAP:

Mean Arterial Pressure

MEP:

Motor evoked potentials

MRI:

Magnetic resonance imaging

NIH:

National Institutes of Health

NIRS:

Near infrared spectroscopy

NO:

Nitric oxide

NOS:

Nitric oxide synthase

O2 :

Oxygen

PaCO2 :

Partial pressure of arterial carbon dioxide

PALS:

Pediatric Advanced Life Support

PaO2 :

Partial pressure of oxygen in arterial blood

PG:

Prostaglandin

PT:

Prothrombin Time

PTT:

Partial Thromboplastin Time

SBP:

Systolic blood pressure

SCI:

Spinal cord injury

SCIWORA:

Spinal cord injury without radiological abnormalities

SDR:

Selective dorsal rhizotomy

SjvO2 :

Jugular venous oxygen saturation

SSEP:

Somatosensory evoked potentials

TBI:

Traumatic Brain Injury

TCD:

Transcranial Doppler

TIVA:

Total intravenous anesthesia

VAE:

Venous air embolus (or emboli)

VBAS :

Basilar artery flow velocity

VMCA :

Middle cerebral artery flow velocity

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Harborview Medical Center, 325 Ninth Avenue, 359724, Seattle, WA, 98104, USA

    Monica S. Vavilala MD

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Sulpicio G. Soriano MD

Authors
  1. Monica S. Vavilala MD
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  2. Sulpicio G. Soriano MD
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Correspondence to Monica S. Vavilala MD .

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Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Vavilala, M.S., Soriano, S.G. (2014). Perioperative Care of the Pediatric Neurosurgical Patient. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6359-6_10

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  • DOI: https://doi.org/10.1007/978-1-4471-6359-6_10

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