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Effects of Dexmedetomidine-Remifentanil on Neurodevelopment of Children after Inhalation Anesthesia: A Randomized

Sang-Hwan Ji1, Pyoyoon Kang2, Sung-Ae Cho3

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Anesthesiology
|September 9, 2025
PubMed

Insights

Adding dexmedetomidine and remifentanil to sevoflurane anesthesia did not impact neurodevelopmental outcomes in young children at 28-30 months. This study found no significant differences in cognitive or behavioral assessments between the groups.

Area of Science:

  • Pediatric Anesthesiology
  • Neurodevelopmental Toxicology
  • Clinical Trial Research

Background:

  • Concerns exist regarding the neurodevelopmental safety of volatile anesthetics in young children.
  • Preclinical studies suggest potential neurotoxicity associated with anesthetic agents.

Purpose of the Study:

  • To evaluate if combining dexmedetomidine and remifentanil with sevoflurane affects neurodevelopmental outcomes in young children.
  • To compare neurodevelopmental status in children receiving sevoflurane alone versus sevoflurane with dexmedetomidine and remifentanil.

Main Methods:

  • Prospective, double-blind, randomized clinical trial involving children under 2 years undergoing surgery.
  • Participants received either sevoflurane alone (control) or sevoflurane with dexmedetomidine and remifentanil (DEX-R).
  • Neurodevelopmental status assessed at 28-30 months using the Korean Leiter International Performance Scale and Child Behavior Checklist.

Main Results:

  • No significant difference in anesthesia duration between the control and DEX-R groups.
  • Mean end-tidal sevoflurane concentration was significantly lower in the DEX-R group (P < 0.001).
  • No significant difference in mean full-scale IQ scores (102.5 DEX-R vs. 103.6 control) or Child Behavior Checklist scores between groups.

Conclusions:

  • The combination of dexmedetomidine and remifentanil with sevoflurane anesthesia did not lead to significant differences in neurodevelopmental outcomes at 28-30 months.
  • Results suggest that this anesthetic combination is safe regarding neurodevelopmental outcomes in the assessed age group.
  • Further long-term follow-up is planned to report the primary endpoint of full-scale IQ at 5 years of age.
Abstract

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