Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia.

Pablo O Sepúlveda,Gustavo Campos,Valeria Epulef,Valeria Epulef

doi:10.3390/jcm10102175

Abstract

Background: Pediatric sedation and anesthesia techniques have plenty of difficulties and challenges. Data on the pharmacologic, electroencephalographic, and neurologic response to anesthesia at different brain development times are only partially known. New data in neuroscience, pharmacology, and intraoperative neuromonitoring will impact changing concepts and clinical practice. In this article, we develop a conversation to guide the debate and search for a view more attuned to the updated knowledge in neurodevelopment, electroencephalography, and clinical pharmacology for the anesthesiologic practice in the pediatric population.

Highlights

A retrospective study with data from 1996 to 2000 showed the impact of multiple surgeries and anesthesia on learning disabilities and the onset of ADHD in children under 3 years of age [1]
The other two studies evaluated the use of general anesthetics and the impact on neurodevelopment, and neuropharmacology was not associated with deficits in intelligence quotient; the parents of multiply exposed children reported increased problems in terms of executive function, behavior, and reading
The conceptualization of pediatric anesthesia, the sedative component, as a pharmacological phenomenon associated principally with neocortical activity, presents many conceptual questions and a deficit of objective data in order to interpret whether the anesthetic action fulfills all the desired objectives

Summary

Introduction

A retrospective study with data from 1996 to 2000 showed the impact of multiple surgeries and anesthesia on learning disabilities and the onset of ADHD in children under 3 years of age [1]. The other two studies evaluated the use of general anesthetics and the impact on neurodevelopment, and neuropharmacology was not associated with deficits in intelligence quotient; the parents of multiply exposed children reported increased problems in terms of executive function, behavior, and reading. All these studies include retrospective or prospective analyses, but they do not differentiate between drug techniques (inhaled or intravenous) and whether electroencephalogram (EEG) brain monitoring was performed or not

The Core of the Current Debate

Findings

Pharmacology