Kim Eun-Hee, Park Jung-Bin, Kim Jin-Tae
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Anesth Pain Med (Seoul). 2024 Oct;19(Suppl 1):S25-S35. doi: 10.17085/apm.24106. Epub 2024 Oct 28.
Cerebral blood flow (CBF) plays a vital role in delivering cerebral oxygen, and the accurate assessment of CBF is crucial for the intraoperative management of critically ill infants. Although the direct measurement of CBF is challenging, CBF velocity (CBFV) can be assessed using transcranial Doppler. Recent advances in point-of-care ultrasound have introduced brain ultrasound as a feasible intraoperative option, in which transfontanelle ultrasonography (TFU) has been applied to measure the CBFV through the anterior fontanelle. However, the intraoperative application of TFU in pediatric patients remains limited. The present review highlights the procedural aspects and clinical applications of TFU for anesthetic and intensive care management in pediatric patients. TFU facilitates the visualization of cerebral vessels and allows a noninvasive assessment of cerebral hemodynamics. The clinical significance of TFU involves its usefulness in various clinical scenarios, including monitoring CBF during cardiac surgery, assessing fluid responsiveness, and estimating intracranial pressure. TFU also enables the detection of cerebral emboli and the evaluation of anatomical abnormalities such as hydrocephalus or intracranial hemorrhage. TFU has demonstrated potential as an invaluable tool in pediatric care, despite limited familiarity among anesthesiologists. Additional research is needed to explore the associations between CBF and clinical outcomes, focusing on autoregulation, the impact of physiological changes, the associations of TFU findings with other brain monitoring tools such as electroencephalography, cerebral oximetry, and the implications of microemboli. TFU is a significant advancement and valuable tool for noninvasively assessing cerebral hemodynamics and CBF in pediatric patients with open fontanelles.
脑血流量（CBF）在输送脑氧方面起着至关重要的作用，准确评估CBF对于危重症婴儿的术中管理至关重要。尽管直接测量CBF具有挑战性，但可以使用经颅多普勒评估脑血流速度（CBFV）。床旁超声的最新进展引入了脑超声作为一种可行的术中选择，其中经囟门超声检查（TFU）已被用于通过前囟测量CBFV。然而，TFU在儿科患者中的术中应用仍然有限。本综述重点介绍了TFU在儿科患者麻醉和重症监护管理中的操作方面和临床应用。TFU有助于脑血管的可视化，并允许对脑血流动力学进行无创评估。TFU的临床意义在于其在各种临床场景中的有用性，包括心脏手术期间监测CBF、评估液体反应性以及估计颅内压。TFU还能够检测脑栓塞并评估解剖学异常，如脑积水或颅内出血。尽管麻醉医生对TFU的熟悉程度有限，但TFU已证明在儿科护理中是一种非常有价值的工具。需要进一步研究来探索CBF与临床结局之间的关联，重点关注自动调节、生理变化的影响、TFU结果与其他脑监测工具（如脑电图、脑氧饱和度测定）的关联以及微栓塞的影响。TFU是一项重大进展，也是一种用于无创评估囟门未闭儿科患者脑血流动力学和CBF的有价值工具。
