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.
Highlights
The practice of pediatric anesthesia has advanced within the last two decades [1,2,3]
The evolution of our clinical pediatric anesthesia practice and further sub-specialization in areas such as pediatric cardiac anesthesia has led us to concerns of anesthetic neurotoxicity in those infants and children that we provide anesthesia for on a routine basis
In a later series of infants and children, EEG analysis was obtained during isoflurane and sevoflurane anesthesia [59]
Summary
The practice of pediatric anesthesia has advanced within the last two decades [1,2,3]. Subspecialty training and board-certification in pediatric anesthesia has provided pediatric anesthesia specialists, which has further validated the specialized, clinical science of providing anesthetic care to newborn infants and young children [4]. Clinical anesthetic care in these children has improved and the practice of providing anesthesia has changed, numerous anesthetics have been performed in young infants and children without obvious neurologic complications. This review article provides a background to the emergence of pediatric anesthesia as a true subspecialty of anesthesia, with board certification recently available to those who have completed fellowship training in the specialty [4]. The evolution of our clinical pediatric anesthesia practice and further sub-specialization in areas such as pediatric cardiac anesthesia has led us to concerns of anesthetic neurotoxicity in those infants and children that we provide anesthesia for on a routine basis
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