Abstract
Dogma established by Millard in 1976 regarding the ideal timing of elective surgery in infants has long centered on the “Rule of 10s” (> 10 weeks of age, > 10 pounds and has > 10g hemoglobin and < 10 white cell count) (Wilhelmsen et al. 1966). These guidelines were built upon archaic anesthetic protocols and do not accurately represent the safety profile of modern-day agents. Opposition to neonatal anesthesia cite concerns regarding GABA-agonists and NMDA-receptor antagonists being associated with a degree of neural apoptosis. Opioids and low-dose dexmedetomidine, a highly selective alpha-2 agonist, remain among the few agents used for anesthesia that have not shown pro-apoptotic activity (Sanders et al. 2010). As such, the divisions of plastics and craniofacial surgery and anesthesiology at Children’s Hospital of Los Angeles created a neonatal neuroprotective anesthetic protocol (NPP) designed with dexmedetomidine as the dominant agent in early cleft lip repair (ECLR).
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