Anesthesia and Sedation Exposure and Neurodevelopmental Outcomes in Infants Undergoing Congenital Cardiac Surgery: A Retrospective Cohort Study

Author:

Simpao Allan F.1ORCID,Randazzo Isabel R.2,Chittams Jesse L.3,Burnham Nancy4,Gerdes Marsha5,Bernbaum Judith C.6,Walker Tia7,Imsdahl Solveig8,DeWitt Aaron G.9,Zackai Elaine H.10,Gaynor J. William11,Loepke Andreas W.12

Affiliation:

1. 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.

2. 2Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

3. 3Biostatistics Consulting Unit, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.

4. 4Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

5. 5Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

6. 6Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

7. 7Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

8. 8Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

9. 9Departments of Anesthesiology and Critical Care Medicine and of Pediatrics and Division of Cardiac Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

10. 10Department of Pediatrics, Division of Human Genetics, and Clinical Genetics Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Obstetrics and Gynecology and Division of Pediatrics in Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

11. 11Division of Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

12. 12Department of Anesthesiology and Critical Care Medicine and Division of Cardiac Anesthesiology Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Abstract

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. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Cited by 12 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Pediatric Sedation Gets a Wake-Up Call;Journal of the American College of Cardiology;2024-09

2. Association of Postnatal Opioid Exposure and 2-Year Neurodevelopmental Outcomes in Infants Undergoing Cardiac Surgery;Journal of the American College of Cardiology;2024-09

3. Unveiling the hidden dangers: a review of non-apoptotic programmed cell death in anesthetic-induced developmental neurotoxicity;Cell Biology and Toxicology;2024-08-02

4. Selected 2023 Highlights in Congenital Cardiac Anesthesia;Journal of Cardiothoracic and Vascular Anesthesia;2024-08

5. Reply to C.T. Matava et al;Journal of Clinical Oncology;2024-07-24

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