title: The influence of neurophysiologic monitoring on the management of pediatric cardiopulmonary bypass.
abstract: We describe a process by which we sought to determine how the addition of intraoperative neurophysiologic monitoring (IONM) impacted the management of cardiopulmonary bypass (CPB) during pediatric cardiac surgery. While maintaining a consistent team of surgeons, anesthesiologists, nurses, and perfusionists, a multi-modal, IONM program was established consisting of Near Infrared Spectroscopy, Transcranial Doppler, and eight channel electroencephalography. A retrospective review of cases from 1 year before the institution of the IONM program was compared with data obtained from cases performed after neurophysiologic monitoring was established as a standard of care for pediatric patients on CPB. This comparative analysis of CPB management revealed a significant increase in the use of donor blood added to the CPB circuit prime as well as in the maintenance of a higher hematocrit during the bypass period after the implementation of IONM. These changes in the management of pediatric CPB correlated with recommendations of previous studies that examined postoperative neurophysiologic outcomes, suggesting that these changes were not only consistent with best practices, but that the presence of IONM data facilitated a transition to evidence-based practice.
authors.affiliation: Department of Anesthesiology, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA. skimatian@hmc.psu.edu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kimatian
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Saliba
authors.forename: Ximena
authors.initials: X
authors.lastname: Soler
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Valentine
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Coleman
authors.forename: Allen R
authors.initials: AR
authors.lastname: Kunselman
authors.forename: H Gregg
authors.initials: HG
authors.lastname: Schuler
authors.forename: Mollie L
authors.initials: ML
authors.lastname: Barnes
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.forename: John L
authors.initials: JL
authors.lastname: Myers
mesh_terms: D002315:Cardiopulmonary Bypass / Q000379:methods*; D004569:Electroencephalography / Q000379:methods*; D006400:Hematocrit / Q000379:methods; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007223:Infant; D016343:Monitoring, Intraoperative / Q000379:methods*; D009424:Nervous System Physiological Phenomena; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*