Anesthesia and the Developing Brain: Relevance to the Pediatric Cardiac Surgery

Abstract

Anesthetic neurotoxicity has been a hot topic in anesthesia for the past decade. It is of special interest to pediatric anesthesiologists. A subgroup of children potentially at greater risk for anesthetic neurotoxicity, based on a prolonged anesthetic exposure early in development, are those children receiving anesthesia for surgical repair of congenital heart disease. These children have a known risk of neurologic deficit after cardiopulmonary bypass for surgical repair of congenital heart disease. Yet, the type of anesthesia used has not been considered as a potential etiology for their neurologic deficits. These children not only receive prolonged anesthetic exposure during surgical repair, but also receive repeated anesthetic exposures during a critical period of brain development. Their propensity to abnormal brain development, as a result of congenital heart disease, may modify their risk of anesthetic neurotoxicity. This review article provides an overview of anesthetic neurotoxicity from the perspective of a pediatric cardiac anesthesiologist and provides insight into basic science and clinical investigations as it relates to this unique group of children who have been studied over several decades for their risk of neurologic injury.

Diffusion tensor imaging detects ventilation-induced brain injury in preterm lambs

“…A further limitation, is that the surgery in of itself is injurious, since there was mild injury observed in the sham lambs compared to the Cont group. This is likely due to using twins exposed to longer isoflurane which is harmful to the preterm brain [ 52 ].…”

Effects of sevoflurane exposure during late pregnancy on brain development of offspring mice

“…Pregnant women clinically undergo not only anesthesia but also surgical procedures. As the repeated pain and stress at an early age would result in damage to developing neurons and later behavioral difficulties , maternal stress during pregnancy caused by surgical stimulation could induce developmental disability of offspring. The change of the body temperature would also affect the outcome of the study.…”

School-Age Test Proficiency and Special Education After Congenital Heart Disease Surgery in Infancy

“…It is possible that medication exposure could have negatively impacted test proficiency. 43, 44 Unfortunately, we did not consistently have neuroimaging in this cohort to explain their cognitive impairment. Genetic testing, including chromosomal microarray, was not performed in most of the infants, so genetic mutations that may contribute to outcome may not have been identified.…”