Central nervous system monitoring in pediatric cardiac surgery

Abstract

During the last decades, significant improvements have been gained in general surgical outcome of congenital heart surgeries. However, we have to focus more on the overall clinical outcome, especially neurodevelopmental aspects. Postoperative neurologic complications have a great impact on outcome, being more frequent and much more serious in smaller age babies; usually neonates are the most vulnerable group. The incidence of major CNS lesions after congenital heart surgeries is not more than 10 %, while the incidence of postoperative cognitive impairments (POCI) may be as high as 50 %. POCI in pediatric CHD surgeries could be one or more of these three: cognitive dysfunction, impairments in organization of motor functions, and emotional and functional dysfunctions (Markowitz et al. Semin Cardiothorac Vasc Anesth 11:59-65, 2007; Ghanayem et al. J Thorac Cardiovasc Surg 140:857-863, 2010; Snookes et al. Pediatrics 125:e818-827, 2010). This chapter reviews the main methods for monitoring CNS in the perioperative period, starting with clinical assessment of CNS status in children and then going to technologies including near infrared spectroscopy (NIRS), electroencephalography (EEG), transcranial Doppler (TCD), and jugular venous oxygen saturation (SjVO2), monitoring depth of anesthesia and evoked potentials. The final goal of this chapter is to introduce the methods to monitor CNS function and routine clinical practice that we can use for prevention of unwanted structural or behavioral CNS lesions.