Pediatric Neuroanesthesia

Abstract

The child’s developing brain is relatively large and has a higher blood flow and oxygen consumption than an adult brain. It is susceptible to diffuse axonal injury and edema during head trauma. Hypotension and hypoxia may contribute to secondary injury after the trauma. Cerebral perfusion pressure is lower in younger ages, but the lowest, safe perfusion pressure is not known. Anesthetic agents cause broadly the same changes to cerebral blood flow and intracranial pressure as they do in adults. Malignant brain tumors are the second commonest cancer in children, and most occur in the posterior fossa. They often cause the triad of headache, vomiting and gait imbalance, and hydrocephalus is often present. Surgery is often performed in the prone position, and much attention is paid to prevent misplacement of the endotracheal tube during anesthesia and surgery. Neonates with lipomeningomyelocele (spina bifida) often have a Chiari malformation and hydrocephalus.

Review Question

• 1. A 10 year old boy has been knocked unconscious by a blow to the head with a hockey stick and has arrived at your pediatric hospital. After appropriate initial management, a CT scan has shown an extradural hematoma. Discuss your anesthetic management for craniotomy.