Perianesthetic neurological adverse events in children: A review of the Wake-Up Safe Database
Related Experiment Video
Updated: Nov 16, 2025
Adaptation of Microelectrode Array Technology for the Study of Anesthesia-induced Neurotoxicity in the Intact Piglet Brain
Published on: May 12, 2018
Kavitha C Raghavan1, Manon Hache2, Purva Bulsara3
1Division of Anesthesiology, St. Jude Children's Research Hospital, Memphis, TN, USA.
Insights
Perianesthetic neurological adverse events in children are rare but serious, with seizures being most common. Identifying preventable factors can improve outcomes and reduce harm.
Area of Science:
- Pediatric Anesthesiology
- Neurology
- Patient Safety
Background:
- Perianesthetic neurological adverse events (NAE) in children are infrequent but carry significant risks.
- Previous studies focused on specific surgical settings like cardiac surgery or regional anesthesia.
Purpose of the Study:
- To characterize pediatric NAE across all surgical and procedural types.
- To evaluate the role of anesthesia in NAE.
- To identify factors contributing to NAE that are amenable to prevention.
Main Methods:
- Retrospective review of anesthetic encounters from the Wake-Up Safe database (January 2010 - December 2017).
Main Results:
- The incidence of NAE was 0.49 per 10,000 pediatric anesthetic encounters.
- Higher odds of NAE were observed in older infants ( > 6 months), those with American Society of Anesthesiologists physical status (ASA PS) of 3-5, or ASA Emergency (ASA E) status.
- Seizures were the most common NAE; 18.1% of affected children died, and 26% suffered permanent harm.
- Patient disease was the primary cause in 74.8% of events, with anesthesia contributing to 18.9%.
- 37.1% of NAE were preventable, including 2 deaths, with factors including inadequate preoptimization and airway management complications.
Conclusions:
- Pediatric perianesthetic neurological injury, though rare, has a poor prognosis.
- Identifying and optimizing contributing factors during perianesthetic care is crucial.
- Findings can inform informed consent and enhance the quality of pediatric anesthesia care.
Background:
Perianesthetic neurological adverse events are rare in children and have been studied in detail in the settings of cardiac surgery and regional anesthesia. Our study aims to characterize perianesthetic neurological adverse events in children in the setting of all types of surgery and diagnostic or interventional procedures, to evaluate anesthesia's role, and to identify factors amenable to prevention.
Methods:
We conducted a retrospective study by reviewing all the anesthetic encounters reported in the Wake-Up Safe database between January 2010 and December 2017.
Results:
The rate of perianesthetic neurological adverse events was 0.49 per 10 000 pediatric anesthetic encounters. The odds of NAE were significantly higher in children who were older than 6 months; had American Society of Anesthesiologists physical status (ASA PS) of 3, 4, or 5; or had American Society of Anesthesiologists Emergency (ASA E) status. Seizures were the most common NAE. Overall, 23 (18.1%) children with neurological adverse events died, and 33 (26%) experienced permanent or severe permanent harm. The risk of death was higher in infants and in children with ASA PS of 3, 4, or 5; ASA E status; preexisting neurological abnormality; or preexisting neurological deficit and in events associated with cardiac arrest or trauma. Anesthesia contributed to 24 (18.9%) events; patient disease was the primary causative factor in 95 (74.8%) adverse events, and 37 (29.1%) events were preventable, including 2 deaths. Preventable factors broadly included inadequate preoptimization, complications during airway management and central venous catheter placement, and suboptimal patient positioning.
Conclusion:
Perianesthetic neurological adverse events are rare in children and have a poor outcome. Our study has described pediatric perianesthetic neurological injury in detail and identified contributing factors that can be optimized during various phases of perianesthetic care. This information can be utilized during the informed consent process and to enhance the quality of care in children receiving anesthesia.
More Related Videos
14:52Recording Brain Electromagnetic Activity During the Administration of the Gaseous Anesthetic Agents Xenon and Nitrous Oxide in Healthy Volunteers
Published on: January 13, 2018
08:49Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
Published on: October 16, 2013
Related Concept Videos
01:12Local Anesthetics: Adverse Effects
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
01:24Parenteral Anesthetics: Overview
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:22Stages of General Anesthesia
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia