Central Nervous System Monitoring in Pediatric Cardiac Surgery

Abstract

During the last decades, significant improvements have been gained in the 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 central nervous system (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 congenital heart disease (CHD) surgeries could be one or more of these three (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; Heneghan and Pollack, Pediatr Clin N Am 64:1147–1165, 2017; Calderon et al., Arch Dis Child 103:49–56, 2018): Cognitive dysfunction, impairments in the organization of motor functions, emotional and functional dysfunction. This chapter reviews the main methods for monitoring CNS in the perioperative period, starting with clinical assessment of CNS status in children; then going to technologies including Near-Infrared Spectroscopy (NIRS), Electroencephalography (EEG), Transcranial Doppler (TCD), Jugular venous oxygen saturation (SjVO2), monitoring depth of anesthesia, and Evoked potentials. The final goal of this chapter is to introduce a range of methods to monitor CNS function in routine clinical practice in such a way that could be used for the prevention of unwanted structural or behavioral CNS lesions.