INTRODUCTION:There is a paucity of literature on intracranial pressure (ICP) monitoring in children. The aim of this study was to ascertain whether ICP monitoring is useful in children with severe traumatic brain injury (TBI).
MATERIALS AND METHODS: Medical records of children between 1 and 12 years, admitted to neurocritical care unit with severe TBI in 2 years, were reviewed. The children were divided into two groups: study group (ICP monitored) and control group (ICP not monitored). Admission demographics, vital parameters, and computed tomographic scan findings were recorded. In the study group, date of ICP catheter insertion/removal with ICP values and treatment carried out for increased ICP were noted. Data on tracheostomy, duration of mechanical ventilation, hospital stay, and outcome at discharge were noted.
RESULTS: Demographic variables were comparable between the two groups. When adjusted for death, no significant difference was observed between the study and the control groups in median duration of mechanical ventilation: 35 days (95% confidence interval [CI]: 12-73) versus 55 days (95% CI: 29-55) (P = 0.96), hospital stay: 36 days (95% CI: 12-73) versus 58 days (95% CI: 29-58) (P = 0.96), and time to tracheostomy: 6 days (95% CI: 5-8) versus 5 days (95% CI: 4-7) (P = 0.49). Mortality rates, incidence of cranial surgeries, and outcome at discharge were also comparable.
CONCLUSION: ICP monitoring did not reduce the incidence of death, cranial surgeries, duration of mechanical ventilation, hospital stay, or improve the outcome at discharge in children with severe TBI.
Epilepsy is a chronic disorder characterized by recurrent seizures due to unknown etiology. In around 30% of patients, seizures become refractory to medical management, and they are candidates for epilepsy surgery. Success of the epilepsy surgery depends on the precise localization of epileptogenic foci and the totality of its removal. Surgery for epilepsy may be diagnostic (seizure localization) or therapeutic (resection of epileptogenic foci or modify the discharges). Significant challenges for anesthetic management of adult and pediatric patients undergoing surgery for epilepsy include altered pharmacokinetics with antiepileptic medications, use of awake craniotomy, special techniques like intraoperative electrocorticography, and/or pharmacological activation of seizure foci. Hence, careful perioperative care of these patients is vital to the success of the surgery.