Features of monitoring the bispectral index in young children with hydrocephalus

Background. Millions of children with neurological di­seases are subjected to general anesthesia every year. The conditions under which surgeries are done in these patients depend on a number of interrelated factors that arise in conditions of neurological deficiency and are often the cause of anesthetic complications. The possibility of using the monitoring of bispectral index in pediat­ric patients with neurological disorders is of particular interest, specifically in those with hydrocephalus against the background of ventriculomegaly. The purpose was to evaluate of the dynamics of bispectral index monitoring in young children with hydrocephalus during ventriculoperitoneal shunting. Materials and methods. The study included 109 children: 59 with acquired form of hydrocephalus who underwent ventriculoperitoneal shunting and 50 without neurological disorders who underwent reconstructive surgery. The study had 5 stages: initial, induction into anesthesia, tracheal intubation, traumatic stage of the operation, awakening. Results. Electroencephalographic analysis in children with hydrocephalus showed the homogeneity of the rearrangements of the bioelectric pattern, which reflected the wide and stable involvement in the pathological process of various cerebral systems with dysfunction of mesencephalic-diencephalic formations, inclu­ding hypothalamic ones, in combination with impaired cortical-subcortical-brainstem interrelations. When analyzing the baseline bispectral index in patients with hydrocephalus, significantly lower values were found compared to neurologically healthy children (89.25 ± 2.52 and 94.80 ± 1.55, respectively). Analysis of changes in the intraoperative bispectral index showed that in the group with hydrocephalus using propofol, during induction upon reaching the first surgical stage of anesthesia according to clinical indications, the bispectral index significantly decreased to 36.00 ± 2.74, which is 30 % less than in children without neurological disorders and 29 % less when using sevoflurane. The groups where propofol was used showed a significant difference in bispectral index between patients with hydrocephalus and neurologically healthy children at all stages of the operation. This indicated that the intraoperative sleep pattern in individuals with hydrocephalus is at abnormal low levels. Conclusions. Hypoperfusion of the medulla, together with impaired cortical-subcortical relationships, affect the value of the bispectral index. The use of propofol in children with hydrocephalus can lead to the development of cerebral ischemia with a decrease in the electrical activity of the brain.