Perioperative patient management in pediatric neurosurgery.
OBJECTIVE
To describe the main pathophysiological differences in neurosurgical procedures between children and adults; the main complications and adverse events resulting from pediatric neurosurgery reported in studies; the singularities in anesthetic and intraoperative management in several neurosurgical diseases; the more specific and common complications and their management in the most frequent pediatric neurosurgical procedures, as well as causes and treatment for the main complications found in children undergoing neurosurgery.


METHODS
A non-systematic review in literature databases PubMed, EMBASE, and SciELO was performed by using the keywords "pediatrics", "children", "neurosurgery", "risk factors", "intraoperative complications", and "postoperative period", as well as their matches in Portuguese and Spanish from January 2001 to January 2011, in addition to using important references from the selected material over any period of time.


RESULTS
The three procedures most commonly performed in children are hydrocephalus, craniostenosis repair, and brain tumor resection. Complications as fever, bleeding, metabolic disturbances (hyponatremia and hyperglycemia), brain swelling, and transient focal deficits (limb weakness, speech and swallowing disorders) are frequent, but their course is often towards prompt improvement. Up to 50% of children may have an uneventful evolution over the postoperative period. Special attention must be given to the prevention of postoperative infections and seizures with the use of a drug therapy that suits each case.


CONCLUSIONS
The complexity of neurosurgical procedures in children is increasing, and observation and recognition of complications in pediatric intensive care units are fundamental. Anticipating complications in order to achieve an early treatment and adverse event prophylaxis can contribute to reduced morbidity and mortality and increased patients' safety.
Instituto da Criança, Hospital das Clínicas, Medical School, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil. emf2002@uol.com.br
Eduardo
E
Mekitarian Filho
Werther Brunow de
WB
Carvalho
Sérgio
S
Cavalheiro
D002648:Child; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors