Anesthesia for pediatric cardiac surgery and brain protection

In the past decades, dramatic advances in medical and surgical treatments have improved the short-term outcomes and early postoperative morbidities and mortalities for neonates, infants, and children with congenital heart disease undergoing cardiac surgeries. Recently, the attention has been focused on the quality of functional recovery resulting from perioperative care, because the problem of neurologic insults has been raised, and acute brain injury possibly affects neurodevelopmental outcomes. The causes of brain injury are multifactorial; however, perioperative management including anesthesia, hypothermia, cardiopulmonary bypass, and surgical techniques could be a contributing factor. Various techniques to minimize the neurologic damage in pediatric cardiac surgery have facilitated complex heart surgery, including pharmacologic and non-pharmacologic interventions. Current expected indices are neuroprotective techniques of cardiopulmonary bypass (deep hypothermic circulatory arrest and regional cerebral perfusion) and neuromonitoring (near-infrared spectroscopy). A number of studies on these approaches in animal models have been investigated. Clinical trials regarding the association between long-term neurological outcomes and brain protection strategies have been increasing; however, high-quality protocols based on large, multicenter, randomized, controlled studies are still insufficient to provide the obvious evidence in this field. We have to identify the current problems and continuously explore these in depth in pediatric cardiac operations.