Lamsal Ritesh, Rath Girija P
Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Curr Opin Anaesthesiol. 2018 Oct;31(5):539-543. doi: 10.1097/ACO.0000000000000630.
Pediatric neuroanesthesia is a fascinating, yet challenging branch of anesthesia. This review highlights some of the recent insights into pediatric neuroanesthesia from the past 18 months.
Although there are incontrovertible evidences in animals suggesting that prolonged exposure to general anesthesia causes long-term neurological impairment, the translational relevance of these findings in humans is debatable. Early surgery for pediatric drug-refractory epilepsy is supported by emerging literature, but poses unique perioperative problems for the treating neuroanesthesiologist. Similarly, minimizing intraoperative blood loss and blood transfusion concerns every anesthesiologist managing small children. The usefulness of tranexamic acid in children is further enhanced by some studies in spine surgeries. Some pertinent issues related to intraoperative neuromonitoring are also discussed in the text.
There are several logistical and ethical problems of carrying out high-quality prospective studies in children but important findings on prevention of anesthetic neurotoxicity; minimizing intraoperative blood loss, intraoperative neurophysiological monitoring, examining optimal doses and choices of anesthetic agents in epilepsy surgery have been published recently.
小儿神经麻醉是麻醉学中一个引人入胜但又具有挑战性的分支。本综述重点介绍了过去18个月里小儿神经麻醉方面的一些最新见解。
尽管动物实验中有确凿证据表明长时间暴露于全身麻醉会导致长期神经功能损害，但这些发现对人类的转化相关性仍存在争议。新出现的文献支持对小儿药物难治性癫痫进行早期手术，但这给治疗小儿神经麻醉医生带来了独特的围手术期问题。同样，将术中失血和输血降至最低是每位为小儿患者实施麻醉的医生所关注的问题。氨甲环酸在脊柱手术中的一些研究进一步证明了其在儿童中的有效性。文中还讨论了与术中神经监测相关的一些相关问题。
在儿童中开展高质量前瞻性研究存在若干后勤和伦理问题，但近期已发表了关于预防麻醉神经毒性、尽量减少术中失血、术中神经生理监测以及研究癫痫手术中麻醉药物的最佳剂量和选择等重要研究结果。
