TY - CHAP M1 - Book, Section TI - Anesthesia for Neurosurgical Procedures A1 - Varadarajan, Jaya A2 - Ellinas, Herodotos A2 - Matthes, Kai A2 - Alrayashi, Walid A2 - Bilge, Aykut PY - 2021 T2 - Clinical Pediatric Anesthesiology AB - FOCUS POINTSThe cranial vault changes structurally from birth through the first 2 years of life. Eighty percent of the intracranial volume consists of brain and interstitial fluid, with blood and cerebrospinal fluid (CSF) making up the remainder. Intracranial compliance is the change in intracranial pressure (ICP) relative to the volume.The open fontanelles and sutures in infancy results in increased intracranial compliance and allows for slow expansion of contents.The Munro-Kellie hypothesis states that the sum of all intracranial volumes is always a constant. Infants are an exception to this rule because of the increased compliance and pliability of the skull. Mass effect of a slow growing tumor or hemorrhage can thus be masked by this compensation.Acute changes in volume due to hemorrhage or obstruction of the CSF flow are not attenuated and can lead to life-threatening consequences.Cerebral perfusion pressure (CPP), the pressure gradient across the brain, is the difference between mean arterial pressure (MAP) at the entrance to the brain and the mean exit pressure (i.e. central venous pressure), or intracranial pressure (ICP) if elevated. It is a more reliable estimate of cerebral perfusion.In adults, cerebral autoregulation maintains a constant brain perfusion despite moderate changes in MAP or ICP. The lower absolute limits of cerebral autoregulation in infants and children is unclear and the range is believed to be narrower in neonates.Acceptable MAP for a neonate is the gestational age in mmHg. Tight blood pressure control is essential in the management of neonates to minimize both cerebral ischemia with hypotension, and intraventricular hemorrhage with hypertension.Certain pediatric disease states have specific anesthetic considerations and require tailoring of the intraoperative anesthetic management to the unique disease condition. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1176457690 ER -