Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia

Figures

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  Figure 1. Up Left: Raw EEG and spectrogram from a 45-year-old patient receiving a typical Propofol anesthesia. Down at the end of the screen, observe the effect of adding Sevoflurane. Right: A 10-year-old child’s raw EEG and spectrogram. The global power and the alfa band (7–12 Hz) is much intense than in adults. (Sedline Monitor).

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  Figure 2. A 6-month-old patient. The EEG shows a spectrogram with very low potency in the alfa band despite low concentrations of propofol (1.6 ug/ml).

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  Figure 3. A typical overdosing of a 12-year-old patient using Propofol children model (Paedfusor) in TCI mode. You can observe a depression in the alfa band in the middle of the spectrogram display (Time is from up to down). This depression is considered a sign of overdosing and requires the reduction of the concentration of propofol observed at the down point of the screen (BIS bilateral monitor left, Ezfusor™ infusion system right). The adequate doses are only 2.2 ug/ml in this case.

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  Figure 4. A 6-weeks old child, 4.3kg, biliary atresia, General anesthesia with Propofol TCI, Remifentanil manual calculation. The raw EEG and the spectrogram show an important depression of the SEF95, many Burst suppression episodes and asymmetry between both hemispheres, no alpha activity using extremely low Propofol concentration.