CLINICAL AND PHYSIOLOGICAL ASPECTS OF ANESTHESIA SELECTION IN CHILDREN WITH BRAIN TUMORS: FROM HEMODYNAMIC PARAMETERS TO POSTOPERATIVE OUTCOMES
Abstract
The choice of anesthetic strategy in children undergoing craniotomy for brain tumors requires a comprehensive assessment not only of intracranial hypertension control, but also of systemic hemodynamics, tissue perfusion, volemic status, and the profile of early postoperative complications. According to contemporary reviews, particular importance in pediatric neuroanesthesiology is attached to the safe maintenance of cerebral perfusion, reduction of the risk of postoperative nausea and vomiting, and the use of noninvasive markers of intracranial pressure, including ultrasonographic measurement of the optic nerve sheath diameter (ONSD).The aim of this review-analytical study was to compare the clinical and physiological effects of propofol and sevoflurane in children with brain tumors on the basis of a statistical analysis of 99 observations. The study included 51 patients in the propofol group and 48 patients in the sevoflurane group. The analysis demonstrated that propofol was associated with more stable mean arterial pressure after intubation and at the end of surgery, lower lactate levels by the completion of the procedure, and a lower incidence of early postoperative complications. At the same time, both anesthetic techniques provided a comparable reduction in ONSD by the end of surgery, indicating equally effective control of intracranial hypertension according to this noninvasive marker.The key clinical conclusions are as follows: baseline ONSD should not be regarded as the sole criterion for anesthetic selection; propofol offers advantages when greater hemodynamic stability, a more favorable metabolic profile, and prevention of postoperative nausea and somnolence are required; sevoflurane remains clinically relevant as an option with a tendency toward faster emergence. The scientific value of the study lies in the development of clinically oriented recommendations for the choice of anesthetic agent and infusion strategy in pediatric neurosurgery.