Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment

Abstract

Neonates have a higher perioperative mortality risk largely due to the degree of prior illness of the infants, the complexity of their surgeries, and infant physiology. It is important to consider contributing anesthetic factors during the perioperative period that may affect cerebral perfusion and neurocognitive outcome, such as alterations in hemodynamics and ventilation. Limitations of blood pressure as a marker for cerebral perfusion are discussed, as well as the effect of hypocapnia on the brain.

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

“…14 Paediatric perioperative risk models can be generated from collaborative databases containing consensus definitions. 41,43 Research is appropriately directed at the potential toxicity of anaesthetic agents, 3,6,7 and at the significance of physiological parameters, 22,25 and will continue to advance the science of paediatric anaesthesia.…”

“…[18][19][20][21] • Research is facilitated and can be appropriately directed to improving clinical anaesthetic safety. [22][23][24][25][26] Definitions of "anaesthetic-related" mortality, cardiac arrest, serious adverse events and critical incidents…”

Neurodevelopmental Outcomes Following Bevacizumab Injections for Retinopathy of Prematurity

“…Laser photoablation of the avascular retina is the standard of care for treatment of ROP and is highly successful. 1 However, concerns regarding risks of intubation and sedation on neurodevelopment, 2 adverse effects such as laser-induced myopia, 3 visual field reduction, 4 and suboptimal visual results in cases of posterior ROP 5 have motivated the search for alternative treatment.…”

Neonatal Anesthesia and Analgesia: Time to Reevaluate Neurodevelopmental Outcomes

“…The reasons for this finding may be different neonatal/infant physiology, higher degree of illness, more complex surgical procedures and the effects of anesthesia and analgesia on developing brain. Importantly, the possible effects of blood pressure and cerebral perfusion changes during and after the surgery have to be elucidated in the future [2]. A relatively large volume of animal data evaluating toxicity of anesthetic and analgesic agents on developing brain exists.…”