Multimodal Neuromonitoring During Pediatric Cardiac Surgery

Abstract Introduction: Neuromonitoring (electroencephalogram [EEG] and cerebral oximetry) is essential for appropriate anesthesia and neuroprotection assessment during pediatric cardiac surgery. Methods: We describe the intraoperative pediatric multimodal and multiparametric neuromonitoring pattern of the software system Neuron-Spectrum (Kandel®) that consists of continuous electroencephalogram (cEEG), spectral analysis, amplitude-integrated electroencephalogram (aEEG), depth of anesthesia monitor (NINDEX), and regional cerebral and somatic oximetry (near-infrared spectroscopy-INVOS™). A physiological algorithm for management using neuromonitoring and physiological data is also described. Results: Visual data examples are presented for interpretation of the cerebral perfusion and oxygenation, neurophysiological state, anesthesia depth, possible neurologic predictions, and identification of cerebral drug effects (EEG signature). Conclusion: The neuromonitoring model can be an effective tool for anesthesia control and to provide adequate cerebral oxygenation during surgery.

Multimodal Neuromonitoring During Pediatric Cardiac Surgery.

INTRODUCTION: Neuromonitoring (electroencephalogram [EEG] and cerebral oximetry) is essential for appropriate anesthesia and neuroprotection assessment during pediatric cardiac surgery. METHODS: We describe the intraoperative pediatric multimodal and multiparametric neuromonitoring pattern of the software system Neuron-Spectrum (Kandel®) that consists of continuous electroencephalogram (cEEG), spectral analysis, amplitude-integrated electroencephalogram (aEEG), depth of anesthesia monitor (NINDEX), and regional cerebral and somatic oximetry (near-infrared spectroscopy-INVOS™). A physiological algorithm for management using neuromonitoring and physiological data is also described. RESULTS: Visual data examples are presented for interpretation of the cerebral perfusion and oxygenation, neurophysiological state, anesthesia depth, possible neurologic predictions, and identification of cerebral drug effects (EEG signature). Conclusion: The neuromonitoring model can be an effective tool for anesthesia control and to provide adequate cerebral oxygenation during surgery.

Hyperplasia of the colonic neuroendocrine cells after pinealectomy in rats. The new evidence for the existence of connections between the distant parts of the diffuse neuroendocrine system.

OBJECTIVES: The diffuse neuroendocrine system (DNES) participates in the systemic homeostasis and may work as a unified system with integrated functions but anatomically disperse. However, the mechanisms that are involved in the integration of the distant parts of the DNES are poorly known. This study is aimed on the effects of a pinealectomy on the population of the neuroendocrine cells (NECs) in the colon of rats. METHODS: A group of seven newborn rats and one of adult rats were submitted to a pinealectomy. The animals were sacrificed after 15 days and 90 days, respectively. The control groups of adult and newborn rats were subjected to a 'sham surgery' and then sacrificed after similar periods of time. Paraffin-included sections of the colon samples were stained by the Churukian-Schenk method in order to selectively stain the NECs. The NEC index was estimated by the expression: iNEC = NECs population per crypt/Total cell population of the crypt. The results were expressed as median and absolute range, and the statistical significance was demonstrated by the Mann-Whitney (U) test. RESULTS: The morphometric analysis showed a significant increase in the number of colonic NECs of the adult rats subjected to a pinealectomy when compared to the controls. No statistical difference was observed between the iNECs of the newborn groups of rats. CONCLUSION: This finding suggests the existence of regulatory mechanisms that integrate distant parts of the DNES, by adapting the population of the endocrine cells after the ablation of an important component of the system. Further studies on the mechanisms involved in the integration of the DNES may be facilitated by the simple experimental model that we propose.