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Anesthesia and Sedation Exposure and Neurodevelopmental Outcomes in Infants Undergoing Congenital Cardiac Surgery: A
Allan F Simpao1, Isabel R Randazzo2, Jesse L Chittams3
1Departments of Anesthesiology and Critical Care Medicine and of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Insights
Ketamine exposure in infants with congenital heart disease undergoing cardiac surgery was linked to lower motor scores at 18 months. Volatile anesthetic agents did not show an association with neurodevelopmental outcomes.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Pediatrics
- Congenital Heart Disease
Background:
- Infants with congenital heart disease (CHD) undergoing complex cardiac surgery receive higher doses of sedatives and anesthetics.
- This population is more frequently anesthetized with ketamine compared to healthy children.
- Concerns exist regarding the neurodevelopmental effects of cumulative anesthetic and sedative exposure in this vulnerable group.
Purpose of the Study:
- To investigate the association between cumulative exposure to sedative and anesthetic medications and neurodevelopmental outcomes in infants with CHD.
- To assess the impact of volatile anesthetic agents, sedative medications, and ketamine on neurodevelopmental scores at 18 months of age.
Main Methods:
- A secondary analysis of a prospective observational study involving infants with CHD.
- Collected data on cumulative exposure to volatile anesthetic agents (minimum alveolar concentration hours) and all operating room/intensive care unit sedative/anesthesia medications.
- Assessed neurodevelopmental outcomes using the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley III) at 18 months.
Main Results:
- No significant association was found between exposure to volatile anesthetic agents, opioids, benzodiazepines, or dexmedetomidine and abnormal Bayley III scores.
- Increased ketamine exposure was significantly associated with a decrease in Bayley III motor scores at 18 months (P = 0.024).
- Each mg/kg increase in ketamine exposure correlated with a 0.34-point decrease in motor scores, after adjusting for confounders.
Conclusions:
- Cumulative exposure to volatile anesthetic agents was not associated with neurodevelopmental impairment in infants with CHD.
- Higher ketamine doses were associated with poorer motor performance in this cohort.
- These findings highlight a potential neurodevelopmental risk associated with ketamine in infants undergoing cardiac procedures.
Background:
Children undergoing complex cardiac surgery are exposed to substantial cumulative doses of sedative medications and volatile anesthetics and are more frequently anesthetized with ketamine, compared with healthy children. This study hypothesized that greater exposure to sedation and anesthesia in this population is associated with lower neurodevelopmental scores at 18 months of age.
Methods:
A secondary analysis was conducted of infants with congenital heart disease who participated in a prospective observational study of environmental exposures and neurodevelopmental outcomes to assess the impact of cumulative volatile anesthetic agents and sedative medications. Cumulative minimum alveolar concentration hours of exposure to volatile anesthetic agents and all operating room and intensive care unit exposures to sedative and anesthesia medications were collected before administration of Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley III), at 18 months of age.
Results:
The study cohort included 41 (37%) single-ventricle and 69 (63%) two-ventricle patients. Exposures to volatile anesthetic agents, opioids, benzodiazepines, and dexmedetomidine were not associated with abnormal Bayley III scores. At 18-month follow-up, after adjusting for confounders, each mg/kg increase in ketamine exposure was associated with a 0.34 (95% CI, -0.64 to -0.05) point decrease in Bayley III motor scores (P = 0.024).
Conclusions:
Total cumulative exposures to volatile anesthetic agents were not associated with neurodevelopmental impairment in infants with congenital heart disease undergoing various imaging studies and procedures, whereas higher ketamine doses were associated with poorer motor performance.
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