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Essentials of Pediatric Neuroanesthesia Essentials of Pediatric Neuroanesthesia Edited by Sulpicio G. Soriano BostonChildren’sHospitalandHarvardMedicalSchool Craig D. McClain BostonChildren’sHospitalandHarvardMedicalSchool UniversityPrintingHouse,CambridgeCB28BS,UnitedKingdom OneLibertyPlaza,20thFloor,NewYork,NY10006,USA 477WilliamstownRoad,PortMelbourne,VIC3207,Australia 314–321,3rdFloor,Plot3,SplendorForum,JasolaDistrictCentre,NewDelhi–110025,India 79AnsonRoad,#06–04/06,Singapore079906 CambridgeUniversityPressispartoftheUniversityofCambridge. ItfurtherstheUniversity’smissionbydisseminatingknowledgeinthepursuitof education,learning,andresearchatthehighestinternationallevelsofexcellence. www.cambridge.org Informationonthistitle:www.cambridge.org/9781316608876 DOI:10.1017/9781316652947 ©CambridgeUniversityPress2019 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress. Firstpublished2019 PrintedintheUnitedKingdombyTJInternationalLtdPadstowCornwall AcataloguerecordforthispublicationisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-Publicationdata Names:Soriano,Sulpicio,editor.|McClain,Craig(CraigD.),editor. Title:Essentialsofpediatricneuroanesthesia/editedbySulpicioSoriano,CraigMcClain. Description:Cambridge,UnitedKingdom;NewYork,NY:CambridgeUniversityPress,2019.| Includesbibliographicalreferencesandindex. Identifiers:LCCN2018028364|ISBN9781316608876 Subjects:|MESH:Anesthesia|NeurosurgicalProcedures|NervousSystemDiseases–surgery|Child Classification:LCCRD139|NLMWO440|DDC617.9/6083–dc23 LCrecordavailableathttps://lccn.loc.gov/2018028364 ISBN978-1-316-60887-6Paperback CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracyof URLsforexternalorthird-partyinternetwebsitesreferredtointhispublication anddoesnotguaranteethatanycontentonsuchwebsitesis,orwillremain, accurateorappropriate. ................................................................................................................................ Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateand up-to-dateinformationthatisinaccordwithacceptedstandardsandpractice atthetimeofpublication.Althoughcasehistoriesaredrawnfromactualcases, everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved. Nevertheless,theauthors,editors,andpublisherscanmakenowarrantiesthatthe informationcontainedhereinistotallyfreefromerror,notleastbecauseclinical standardsareconstantlychangingthroughresearchandregulation.Theauthors, editors,andpublishersthereforedisclaimallliabilityfordirectorconsequential damagesresultingfromtheuseofmaterialcontainedinthisbook.Readers arestronglyadvisedtopaycarefulattentiontoinformationprovidedbythe manufacturerofanydrugsorequipmentthattheyplantouse. This book is dedicated to my family(Carmen A. Perez, Richard, Steven, Laura,Teresa,Sara,Kristen,Isa,KoaandLeoSoriano)andmentors(Babu V. Koka and Gerald A. Gronert) who have blessed me with unwavering supportandguidance. SGS IwouldliketodedicatethisworktothethreegroupsofpeoplethatIwill foreverbe indebtedto for anythinggoodI’ve been ableto do inmy life. Firstandforemost,Iwanttothankmyfamily—Natalie,Isla,Callum,and FinlayaswellastheextendedMcClains,Murphys,andVuyks.Thanksfor yourcontinuedsupport,patience,andunderstanding.Iamanincredibly lucky man to have you all in my life, and I love you all so very much.Second,I’dliketothankmymentorsthroughoutmytrainingand practicewhohavetriedtoteachmehowtobeagoodandcaringdoctor. Acompletelistisimpossible,butI’dliketosingleoutTerryYemen,Keith Littlewood,SolSoriano,MikeMcManus,andBobHolzmanasfolksthat I find myself quoting and emulating on a daily basis. Finally, and most importantly to this book, I’d like to thank the patients and families that have allowed me to participate in their care and hopefully help them as theynegotiateoftenPrometheantasks.Iamhumbledonadailybasisby thegracewithwhichtheygoabouttheirlivesduringtimesthatareoften unfathomablydifficult.Thankyou. CDM Contents ListofContributors viii Preface xi 1. DevelopmentalApproachtothePediatric 13. EpilepsySurgery 102 NeurosurgicalPatient 1 HubertA.Benzon,DouglasHale JueWangandSulpicioG.Soriano McMichael,andCraigD.McClain 2. DevelopmentalCerebrovascular 14. TraumaticBrainInjury 112 Physiology 9 DavidLevin,MonicaS.Vavilala,and JenniferK.LeeandKenM.Brady SulpicioG.Soriano 3. NeuroprotectiveStrategiesinthePediatric 15. AnesthesiaforMinimallyInvasive Patient 15 Neurosurgery 120 RebeccaDubeandJasonT.Maynes PetraM.MeierandThomasO.Erb 4. Neuropharmacology 23 16. IntraoperativeNeuromonitoringinPediatric CharuMahajan,InduKapoor,and Neurosurgery 135 HemanshuPrabhakar JohnMcAuliffe 5. BloodSparingTechniques 32 17. AnesthesiaforNeurointerventional SusanM.GoobieandDavidFaraoni Radiology 147 MaryLandrigan-Ossar 6. RegionalAnesthesiaforPediatric Neurosurgery 45 18. RadiationTherapy 153 RaviShahandSanthanamSuresh ThejovathiEdala,RahulKoka,andBabu V.Koka 7. AnesthesiaforPosteriorFossa Craniotomy 52 19. Anesthetic-InducedNeurotoxicity 159 AudriceFrancoisandSulpicioG.Soriano MaryEllenMcCann 8. CongenitalNeurosurgicalLesions 58 20. PerioperativeSaltandWaterinPediatric CynthiaTung,LazsloVutskits,and NeurocriticalCare 173 SulpicioG.Soriano RobertC.TaskerandFrederickVonberg 9. AnestheticConsiderationsforDeepBrain 21. IntensiveCareConsiderationsofPediatric StimulatorPlacement 65 Neurosurgery 183 EricDarrow CraigD.McClainandMichael L.McManus 10. AnesthesiaforFetalNeurosurgery 77 ElainaE.LinandKhaM.Tran 11. AnesthesiaforCraniofacialSurgery 86 ElainaE.LinandPaulA.Stricker Index 190 12. AnesthesiaforCerebrovascularDiseasein Children 92 LauraC.RheeandCraigD.McClain vii Contributors HubertA.Benzon BabuV.Koka AnnandRobertH.LurieChildren’sHospitalof BostonChildren’sHospitalandHarvardMedical ChicagoandNorthwesternUniversityFeinberg School,Boston,MA,USA SchoolofMedicine,Chicago,IL,USA RahulKoka KenM.Brady JohnsHopkinsChildren’sCenterandJohnsHopkins AnnandRobertH.LurieChildren’sHospitalof University,Baltimore,MD,USA ChicagoandNorthwesternUniversityFeinberg MaryLandrigan-Ossar SchoolofMedicine,Chicago,IL,USA BostonChildren’sHospitalandHarvardMedical EricDarrow School,Boston,MA,USA CookChildren’sHospital,FortWorth,TX,USA JenniferK.Lee RebeccaDube JohnsHopkinsChildren’sCenterandJohnsHopkins HospitalforSickChildrenandUniversityofToronto University,Baltimore,MD,USA SchoolofMedicine,Toronto,Canada DavidLevin ThejovathiEdala HospitalforSickChildrenandUniversityofToronto Arkansas Children’s Hospital and University of SchoolofMedicine,Toronto,Canada Arkansas for Medical Sciences, Little Rock, AR, ElainaE.Lin USA Children’sHospitalofPhiladelphiaandPerelman ThomasO.Erb SchoolofMedicineattheUniversityofPennsylvania, UniversityChildren’sHospitalandUniversityof Philadelphia,PA,USA Basel,Basel,Switzerland CharuMahajan DavidFaraoni AllIndiaInstituteofMedicalSciences(AIIMS),New HospitalforSickChildrenandUniversityofToronto Delhi,India SchoolofMedicine,Toronto,Canada JasonT.Maynes AudriceFrancois HospitalforSickChildrenandUniversityofToronto StritchSchoolofMedicineofLoyolaUniversity SchoolofMedicine,Toronto,Canada Chicago,Chicago,IL,USA JohnMcAuliffe SusanM.Goobie CincinnatiChildren’sHospitalMedicalCenterand BostonChildren’sHospitalandHarvardMedical UniversityofCincinnatiCollegeofMedicine, School,Boston,MA,USA Cincinnati,OH,USA InduKapoor MaryEllenMcCann AllIndiaInstituteofMedicalSciences(AIIMS),New BostonChildren’sHospitalandHarvardMedical Delhi,India School,Boston,MA,USA viii ListofContributors CraigD.McClain UniversityofPennsylvania,Philadelphia, BostonChildren’sHospitalandHarvardMedical PA,USA School,Boston,MA,USA SanthanamSuresh MichaelL.McManus AnnandRobertH.LurieChildren’s BostonChildren’sHospitalandHarvardMedical HospitalofChicagoandNorthwestern School,Boston,MA,USA UniversityFeinbergSchoolofMedicine, Chicago,IL,USA DouglasHaleMcMichael AnnandRobertH.LurieChildren’s RobertC.Tasker HospitalofChicagoandNorthwestern BostonChildren’sHospitalandHarvardMedical UniversityFeinbergSchoolofMedicine, School,Boston,MA,USA Chicago,IL,USA KhaM.Tran PetraM.Meier Children’sHospitalofPhiladelphiaand BostonChildren’sHospitalandHarvardMedical PerelmanSchoolofMedicineatthe School,Boston,MA,USA UniversityofPennsylvania,Philadelphia, PA,USA HemanshuPrabhakar AllIndiaInstituteofMedicalSciences(AIIMS),New CynthiaTung Delhi,India BostonChildren’sHospitalandHarvardMedical School,Boston,MA,USA LauraC.Rhee BostonChildren’sHospitalandHarvardMedical MonicaS.Vavilala School,Boston,MA,USA HarborviewMedicalCenterandUniversityof Washington,Seattle,WA,USA RaviShah AnnandRobertH.LurieChildren’s FrederickVonberg HospitalofChicagoandNorthwesternUniversity BostonChildren’sHospitalandHarvardMedical FeinbergSchoolofMedicine,Chicago,IL,USA School,Boston,MA,USA SulpicioG.Soriano LazsloVutskits BostonChildren’sHospitalandHarvardMedical UniversityHospitalGenevaandUniversityof School,Boston,MA,USA Geneva,Geneva,Switzerland PaulA.Stricker JueWang Children’sHospitalofPhiladelphiaand BostonChildren’sHospitalandHarvardMedical PerelmanSchoolofMedicineatthe School,Boston,MA,USA ix