Pediatric neuroanesthesia experiences: A single center retrospective cohort study

Neuroanesthesia in pediatric patients

Authors

Keywords:

anesthesia, neurosurgery, pediatric neuroanesthesia

Abstract

Background/Aim: Pediatric neuroanesthesia is a special field that requires significant experience and infrastructure because of anatomical, neurological, and pharmacological differences in the pediatric patient population. Although technological improvements provide more effective and safer neuroanesthesiological management, the principles of neuroanesthesia, neurocognitive development, and the effects of anesthetic agents on central nervous system development are well-known. The majority of pediatric neuroanesthesia articles in the literature are reviews; however, retrospective/prospective case series and controlled research are limited. In this retrospective cohort study, we aimed to contribute to the existing literature by reviewing and analyzing our single-center 10-year experiences and results addressing pediatric neuroanesthesia management.

Methods: After ethical committee approval, anesthetic and surgical reports from 1165 pediatric neurosurgical cases over ten years were collected. Demographic data, intra-operative vascular management, anesthesia techniques, airway management, patient positions, analgesia methods, and complications were evaluated in this retrospective cohort study. The available surgical intervention, patient positions, intra-operative neuromonitorization (IONM), and intra-operative magnetic resonance imaging (IOMR) records were also analyzed.

Results: Six-hundred forty-six (55.4%) girls and 519 (44.5%) boys were included in the study. The median age was 60 (0–216) months. Cranial interventions were performed in 842 (72.3%) patients, and spinal interventions were performed in 323 (27.7%) patients. Patients’ American Society of Anesthesiologists (ASA) physical scales grouped as I, II, III, and IV were 718 (61.6%), 360 (30.9%), 82 (7%), and 5 (0.4%), respectively. Sevoflurane (40.3%), propofol (37.2%), and sodium thiopental (2.5%) were used for anesthetic induction. Neuromuscular block was performed with rocuronium (56.7%) and atracurium (14.4%). Neuromuscular blocking agents were not used in 337 patients (28.9%). A blood transfusion was required in 120 patients (10.3%), and 40% of these patients underwent surgery for craniosynostosis. Two-hundred twenty-two (19.1%) were monitored with IONM, and IOMR was carried out in 124 (10.6%) of the cases. The anesthesia-related complication rate was 5.15% (60 patients).

Conclusion: Although pediatric neurosurgical interventions involve high risks, they are becoming increasingly common in our daily practice. Neuroanesthesiologists should know the procedures, techniques, and advances for safe and effective management of pediatric neurosurgical cases. We think that these data may be helpful as a guide for the anesthetic management of pediatric neurosurgical cases.

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References

Rath GP, Dash HH. Anaesthesia for neurosurgical procedures in paediatric patients. Indian J Anaesth. 2012 Sep;56(5):502-10. doi: 10.4103/0019-5049.103979. PMID: 23293391; PMCID: PMC3531007. DOI: https://doi.org/10.4103/0019-5049.103979

Soriano SG, Eldredge EA, Rockoff MA. Pediatric neuroanesthesia. Neuroimaging Clin N Am. 2007 May;17(2):259-67. doi: 10.1016/j.nic.2007.03.010. PMID: 17645975. DOI: https://doi.org/10.1016/j.nic.2007.03.010

Kalita N, Goswami A, Goswami P. Making Pediatric Neuroanesthesia Safer. J Pediatr Neurosci. 2017 Oct-Dec;12(4):305-312. doi: 10.4103/jpn.JPN_173_17. PMID: 29675067; PMCID: PMC5890548. DOI: https://doi.org/10.4103/JPN.JPN_173_17

Heaney M. (2020). Pediatric Neuroanesthesia. In: Sims C, Weber D, Johnson C. (eds) A Guide to Pediatric Anesthesia. Springer, Cham.pp.957-978.

McClain CD, Landrigan-Ossar M. Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. Anesthesiol Clin. 2014 Mar;32(1):83-100. doi: 10.1016/j.anclin.2013.10.009. Epub 2013 Dec 8. PMID: 24491651. DOI: https://doi.org/10.1016/j.anclin.2013.10.009

Çetinkaya H, Sarıhasan BB, Bilgin S, Dost B, Turunç E, Çetinkaya G. Retrospective analysis of the patients undergoing neuroanaesthesia between the years 2015-2019 J Exp Clin Med. 2022;39(2):521-4. doi: 10.52142/omujecm.39.2.42. DOI: https://doi.org/10.52142/omujecm.39.2.42

Neervoort FW, Van Ouwerkerk WJ, Folkersma H, Kaspers GJ, Vandertop WP. Surgical morbidity and mortality of pediatric brain tumors: a single center audit. Childs Nerv Syst. 2010 Nov;26(11):1583-92. doi: 10.1007/s00381-010-1086-1. Epub 2010 Mar 5. PMID: 20204381; PMCID: PMC2974195. DOI: https://doi.org/10.1007/s00381-010-1086-1

Furay C, Howell T. Paediatric neuroanaesthesia. Continuing Education in Anaesthesia Critical Care & Pain. 2010 Dec; 10(6):172–176. DOI: https://doi.org/10.1093/bjaceaccp/mkq036

Kunhahamed MO, Abraham SV, Palatty BU, Krishnan SV, Rajeev PC, Gopinathan V. A Comparison of Internal Jugular Vein Cannulation by Ultrasound-Guided and Anatomical Landmark Technique in Resource-Limited Emergency Department Setting. J Med Ultrasound. 2019 May 13;27(4):187-91. doi: 10.4103/JMU.JMU_2_19. PMID: 31867192; PMCID: PMC6905261. DOI: https://doi.org/10.4103/JMU.JMU_2_19

Duffy CM, Matta BF. Sevoflurane and anesthesia for neurosurgery: a review. J Neurosurg Anesthesiol. 2000 Apr;12(2):128-40. doi: 10.1097/00008506-200004000-00012. PMID: 10774610. DOI: https://doi.org/10.1097/00008506-200004000-00012

Chidambaran V, Costandi A, D'Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. 2015 Jul;29(7):543-63. doi: 10.1007/s40263-015-0259-6. Erratum in: CNS Drugs. 2018 Sep;32(9):873. PMID: 26290263; PMCID: PMC4554966. DOI: https://doi.org/10.1007/s40263-015-0259-6

Zhou Z, Ying M, Zhao R. Efficacy and safety of sevoflurane vs propofol in combination with remifentanil for anesthesia maintenance during craniotomy: A meta-analysis. Medicine (Baltimore). 2021 Dec 23;100(51):e28400. doi: 10.1097/MD.0000000000028400. PMID: 34941178; PMCID: PMC8702137. DOI: https://doi.org/10.1097/MD.0000000000028400

Ghoneim AA, Azer MS, Ghobrial HZ, El Beltagy MA. Awakening properties of isoflurane, sevoflurane, and desflurane in pediatric patients after craniotomy for supratentorial tumours. J Neurosurg Anesthesiol. 2015 Jan;27(1):1-6. doi: 10.1097/ANA.0000000000000058. PMID: 24633212. DOI: https://doi.org/10.1097/ANA.0000000000000058

Fairgrieve R, Rowney DA, Karsli C, Bissonnette B. The effect of sevoflurane on cerebral blood flow velocity in children. Acta Anaesthesiol Scand. 2003 Nov;47(10):1226-30. doi: 10.1046/j.1399-6576.2003.00248.x. PMID: 14616319. DOI: https://doi.org/10.1046/j.1399-6576.2003.00248.x

Cole CD, Gottfried ON, Gupta DK, Couldwell WT. Total intravenous anesthesia: advantages for intracranial surgery. Neurosurgery. 2007 Nov;61(5 Suppl 2):369-77; discussion 377-8. doi: 10.1227/01.neu.0000303996.74526.30. PMID: 18091252. DOI: https://doi.org/10.1227/01.neu.0000303996.74526.30

Preethi J, Bidkar PU, Cherian A, Dey A, Srinivasan S, Adinarayanan S, et al. Comparison of total intravenous anesthesia vs. inhalational anesthesia on brain relaxation, intracranial pressure, and hemodynamics in patients with acute subdural hematoma undergoing emergency craniotomy: a randomized control trial. Eur J Trauma Emerg Surg. 2021 Jun;47(3):831-7. doi: 10.1007/s00068-019-01249-4. Epub 2019 Oct 29. PMID: 31664468. DOI: https://doi.org/10.1007/s00068-019-01249-4

Narayanan H, Raistrick C, Tom Pierce JM, Shelton C. Carbon footprint of inhalational and total intravenous anaesthesia for paediatric anaesthesia: a modelling study. Br J Anaesth. 2022 Aug;129(2):231-43. doi: 10.1016/j.bja.2022.04.022. Epub 2022 Jun 18. PMID: 35729012. DOI: https://doi.org/10.1016/j.bja.2022.04.022

Totonchi Z, Seyed Siamdoust SA, Zaman B, Rokhtabnak F, Alavi SA. Comparison of laryngeal mask airway (LMA) insertion with and without muscle relaxant in pediatric anesthesia; a randomized clinical trial. Heliyon. 2022 Nov 13;8(11):e11504. doi: 10.1016/j.heliyon.2022.e11504. PMID: 36406720; PMCID: PMC9672355. DOI: https://doi.org/10.1016/j.heliyon.2022.e11504

Nunes RR, Bersot CDA, Garritano JG. Intraoperative neurophysiological monitoring in neuroanesthesia. Curr Opin Anaesthesiol. 2018 Oct;31(5):532-8. doi: 10.1097/ACO.0000000000000645. PMID: 30020157. DOI: https://doi.org/10.1097/ACO.0000000000000645

Udayakumaran S, Nair NS, George M. Intraoperative Neuromonitoring for Tethered Cord Surgery in Infants: Challenges and Outcome. Pediatr Neurosurg. 2021;56(6):501-10. doi: 10.1159/000518123. Epub 2021 Aug 30. PMID: 34515213. DOI: https://doi.org/10.1159/000518123

Strike SA, Hassanzadeh H, Jain A, Kebaish KM, Njoku DB, Becker D, et al. Intraoperative Neuromonitoring in Pediatric and Adult Spine Deformity Surgery. Clin Spine Surg. 2017 Nov;30(9):E1174-81. doi: 10.1097/BSD.0000000000000388. PMID: 27231831. DOI: https://doi.org/10.1097/BSD.0000000000000388

Sala F, Krzan MJ, Deletis V. Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst. 2002 Jul;18(6-7):264-87. doi: 10.1007/s00381-002-0582-3. Epub 2002 Jun 13. PMID: 12172930.2 DOI: https://doi.org/10.1007/s00381-002-0582-3

Tewari A, Francis L, Samy RN, Kurth DC, Castle J, Frye T, et al. Intraoperative neurophysiological monitoring team's communiqué with anesthesia professionals. J Anaesthesiol Clin Pharmacol. 2018 Jan-Mar;34(1):84-93. doi: 10.4103/joacp. JOACP_315_17. PMID: 29643629; PMCID: PMC5885456. DOI: https://doi.org/10.4103/joacp.JOACP_315_17

Gunter A, Ruskin KJ. Intraoperative neurophysiologic monitoring: utility and anesthetic implications. Curr Opin Anaesthesiol. 2016 Oct;29(5):539-43. doi: 10.1097/ACO.0000000000000374. PMID: 27380045. DOI: https://doi.org/10.1097/ACO.0000000000000374

Rao S, Kurfess J, Treggiari MM. Basics of Neuromonitoring and Anesthetic Considerations. Anesthesiol Clin. 2021 Mar;39(1):195-209. doi: 10.1016/j.anclin.2020.11.009. PMID: 33563382. DOI: https://doi.org/10.1016/j.anclin.2020.11.009

Sivapurapu V, Subramani Y, Vasudevan A. "Externally reinforced endotracheal tube" in a pediatric neurosurgical patient. J Neurosurg Anesthesiol. 2012 Jan;24(1):82-3. doi: 10.1097/ANA.0b013e31823eb20f. PMID: 22134412. DOI: https://doi.org/10.1097/ANA.0b013e31823eb20f

Gilbertson LE, Morgan M, Lam HV. Endotracheal Tube Kinking in the Prone Position during Pediatric Neurosurgery: A Case Report. Children (Basel). 2022 Oct 6;9(10):1530. doi: 10.3390/children9101530. PMID: 36291466; PMCID: PMC9600991. DOI: https://doi.org/10.3390/children9101530

Dilmen OK, Akcil EF, Tureci E, Tunali Y, Bahar M, Tanriverdi T, et al. Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases. Turk Neurosurg. 2011;21(4):634-40. PMID: 22194128.

Thijs D, Menovsky T. The Mayfield Skull Clamp: A Literature Review of Its Complications and Technical Nuances for Application. World Neurosurg. 2021 Jul;151:102-9. doi: 10.1016/j.wneu.2021.04.081. Epub 2021 Apr 30. PMID: 33940273. DOI: https://doi.org/10.1016/j.wneu.2021.04.081

Xing F, An LX, Xue FS, Zhao CM, Bai YF. Postoperative analgesia for pediatric craniotomy patients: a randomized controlled trial. BMC Anesthesiol. 2019 Apr 11;19(1):53. doi: 10.1186/s12871-019-0722-x. PMID: 30971217; PMCID: PMC6458833. DOI: https://doi.org/10.1186/s12871-019-0722-x

Berger M, Philips-Bute B, Guercio J, Hopkins TJ, James ML, Borel CO, et al. A novel application for bolus remifentanil: blunting the hemodynamic response to Mayfield skull clamp placement. Curr Med Res Opin. 2014 Feb;30(2):243-50. doi: 10.1185/03007995.2013.855190. Epub 2013 Oct 30. PMID: 24161010. DOI: https://doi.org/10.1185/03007995.2013.855190

Smyth MD, Banks JT, Tubbs RS, Wellons JC 3rd, Oakes WJ. Efficacy of scheduled nonnarcotic analgesic medications in children after suboccipital craniectomy. J Neurosurg. 2004 Feb;100(2 Suppl Pediatrics):183-6. doi: 10.3171/ped.2004.100.2.0183. PMID: 14758947. DOI: https://doi.org/10.3171/ped.2004.100.2.0183

Vadivelu N, Kai AM, Tran D, Kodumudi G, Legler A, Ayrian E. Options for perioperative pain management in neurosurgery. J Pain Res. 2016 Feb 10;9:37-47. doi: 10.2147/JPR.S85782. PMID: 26929661; PMCID: PMC4755467. DOI: https://doi.org/10.2147/JPR.S85782

Kulikov A, Tere V, Sergi PG, Bilotta F. Prevention and treatment of postoperative pain in pediatric patients undergone craniotomy: Systematic review of clinical evidence. Clin Neurol Neurosurg. 2021 Apr 1;205:106627. doi: 10.1016/j.clineuro.2021.106627. Epub ahead of print. PMID: 33857811. DOI: https://doi.org/10.1016/j.clineuro.2021.106627

Xiong W, Li L, Bao D, Wang Y, Liang Y, Lu P, et al. Postoperative analgesia of scalp nerve block with ropivacaine in pediatric craniotomy patients: a protocol for a prospective, randomized, placebo-controlled, double-blinded trial. Trials. 2020 Jun 26;21(1):580. doi: 10.1186/s13063-020-04524-7. PMID: 32586348; PMCID: PMC7318534. DOI: https://doi.org/10.1186/s13063-020-04524-7

Festa R, Tosi F, Pusateri A, Mensi S, Garra R, Mancino A, et al. The scalp block for postoperative pain control in craniosynostosis surgery: a case control study. Childs Nerv Syst. 2020 Dec;36(12):3063-70. doi: 10.1007/s00381-020-04661-z. Epub 2020 May 17. PMID: 32418049. DOI: https://doi.org/10.1007/s00381-020-04661-z

Ning L, Jiang L, Zhang Q, Luo M, Xu D, Peng Y. Effect of scalp nerve block with ropivacaine on postoperative pain in pediatric patients undergoing craniotomy: A randomized controlled trial. Front Med (Lausanne). 2022 Sep 7;9:952064. doi: 10.3389/fmed.2022.952064. PMID: 36160174; PMCID: PMC9489944. DOI: https://doi.org/10.3389/fmed.2022.952064

van Lindert EJ, Arts S, Blok LM, Hendriks MP, Tielens L, van Bilsen M, et al. Intraoperative complications in pediatric neurosurgery: review of 1807 cases. J Neurosurg Pediatr. 2016 Sep;18(3):363-71. doi: 10.3171/2016.3.PEDS15679. Epub 2016 May 27. PMID: 27231823. DOI: https://doi.org/10.3171/2016.3.PEDS15679

Tay CL, Tan GM, Ng SB. Critical incidents in paediatric anaesthesia: an audit of 10 000 anaesthetics in Singapore. Paediatr Anaesth. 2001 Nov;11(6):711-8. doi: 10.1046/j.1460-9592.2001.00767.x. PMID: 11696149. DOI: https://doi.org/10.1046/j.1460-9592.2001.00767.x

Harrison EA, Mackersie A, McEwan A, Facer E. The sitting position for neurosurgery in children: a review of 16 years' experience. Br J Anaesth. 2002 Jan;88(1):12-7. doi: 10.1093/bja/88.1.12. PMID: 11881865. DOI: https://doi.org/10.1093/bja/88.1.12

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Published

2023-03-09

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Research Article

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1.
Emmez G, İnan G, Pampal HK, Şıvgın V, Güleç Kılıç A, Börcek A Özgün, Özköse Şatırlar Z. Pediatric neuroanesthesia experiences: A single center retrospective cohort study: Neuroanesthesia in pediatric patients. J Surg Med [Internet]. 2023 Mar. 9 [cited 2024 Oct. 12];7(3):214-9. Available from: https://jsurgmed.com/article/view/7731