Perioperative neuromonitoring in pediatric cardiac surgery: Techniques and targets

Cerebral injury occurs with moderate frequency in patients with congenital heart disease. Physiology, measurement techniques, and targets for intervention in the perioperative period will be reviewed. The pathophysiology of neurologic injury is multi-factorial, but hypoxic–ischemic mechanisms are significant. Measures of oxygen supply, demand, and balance, and of cerebral function, can help identify conditions of risk and become targets for intervention. Measure of cerebral oxygen status with near-infrared spectroscopy is a practical component of comprehensive perioperative strategy that aims to avoid hypoxic–ischemic injury, and has validation in experimental and clinical literature related to pathophysiology, detection, treatment, and outcome.