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14-08-2011 | Surgery | Article

Surgical sedative, analgesia use unlikely to hinder infant neurodevelopment


Free abstract

MedWire News: Findings from a prospective study indicate that the dose and duration of sedative and analgesia used in complex neonatal heart surgery is unrelated to the risk for neurodevelopmental problems in infancy.

These results contradict previous animal studies suggesting that anesthetic drugs may hinder infant neurodevelopment by causing cell death and neurodegeneration in the human neonate's brain, the authors explain.

The study was based on the hypothesis that the longer a neonate receives sedation, the worse their neurodevelopmental outcomes would be; however, the authors found no evidence in support of this theory.

Ari Joffe, from the University of Alberta in Edmonton, Canada, and team analyzed the 18-24-month neurodevelopmental outcomes of 95 neonates aged 6 weeks or younger who were admitted to an intensive care unit after undergoing congenital heart disease surgery.

They assessed adaptive motor skills (determined via Adaptive Behavior Assessment System scores), significant mental and motor delay (determined by Bayley Scales score of <70), and significant vocabulary delay (determined by Language Development Survey scores ≥15th percentile).

As reported in the journal Pediatric Anesthesia, the team calculated the dose of opiods, benzodiazepines, ketamine, chloral hydrate, and inhalationals received by each neonate per day of postoperative sedation, while receiving mechanical ventilation. The total number of days the drugs were administered was also assessed.

Univariate analysis revealed that each additional day of postoperative ventilation increased the risk for mental delay by 14%, and each additional day of age at surgery increased this risk by 9%.

However, these findings lost significance on multivariate analysis, such that Joffe and team found no significant correlation between the dose and duration of sedative or analgesic drug therapy and end-of-study neurodevelopmental outcomes.

"Being an observational cohort study with a relatively small sample, we cannot rule out that other confounders could have affected the results," say Joffe and colleagues.

Indeed, they advise that their results should be "interpreted with caution," and conclude that further research is required to confirm the findings.

By Lauretta Ihonor

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