Neurological monitoring for congenital heart surgery.
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.
Andropoulos
Dean B
DB
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.
Stayer
Stephen A
SA
Diaz
Laura K
LK
Ramamoorthy
Chandra
C
D000293:Adolescent; D001923:Brain Chemistry / Q000502:physiology; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016343:Monitoring, Intraoperative / Q000009:adverse effects; D009460:Neurologic Examination; D010100:Oxygen / Q000097:blood; D017585:Ultrasonography, Doppler, Transcranial
D010100:Oxygen