Anaesthetic considerations for surgery in newborns
Abstract
Almost 30 years ago, the American Academy of Pediatrics Committee on Fetus and Newborn coauthored a policy statement strongly advocating for the use of anaesthesia in all neonates stating 'local or systemic pharmacologic agents now available permit relatively safe administration of anesthesia or analgesia to neonates undergoing surgical procedures and that such administration is indicated according to the usual guidelines for the administration of anesthesia to high-risk, potentially unstable patients'. With current techniques and advanced monitoring, preterm and full-term infants routinely undergo surgical procedures under general anaesthesia to repair congenital defects that were lethal in years past. Recent research in immature animal models, however, has shown evidence of enhanced neuroapoptosis and other signs of neurotoxicity with all of the currently used anaesthetic agents. There is also increasing concern about the potential adverse effects of perioperative hypotension and hypocapnia on neurocognitive development in infants. This review outlines the most recent animal and human evidence regarding the effects of general anaesthesia and anaesthetic-related haemodynamic changes on the developing brain of newborns.
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When hemodynamic instability occurs, limited cardiac reserve increases the risk of postoperative respiratory and cardiac complications compared to other age groups.
“When hemodynamic instability occurs, limited cardiac reserve increases the risk of postoperative respiratory and cardiac complications compared to other age groups (3).”
From Innovative wearable technology for continuous echocardiographic monitoring: first-in-neonate case report (2025) · cites this paper as [3]
Cites
Excitatory actions of gaba during development: the nature of the nurture
Ben-Ari, Y. (2002) · Nature Reviews Neuroscience · doi:10.1038/nrn920 · Cited by 2,448 · see citing works
Blockade of NMDA Receptors and Apoptotic Neurodegeneration in the Developing Brain
Ikonomidou, C., Bosch, F., Miksa, M., Bittigau, P., Vöckler, J., Dikranian, K., Tenkova, T. I., Stefovska, V., Turski, L., & Olney, J. W. (1999) · Science · doi:10.1126/science.283.5398.70 · Cited by 2,055 · see citing works
Jevtovic-Todorovic, V., Hartman, R. E., Izumi, Y., Benshoff, N. D., Dikranian, K., Zorumski, C. F., Olney, J. W., & Wozniak, D. F. (2003) · The Journal of Neuroscience · doi:10.1523/jneurosci.23-03-00876.2003 · Cited by 1,983 · see citing works
Pain and Its Effects in the Human Neonate and Fetus
Anand, K. J. S., & Hickey, P. R. (1987) · New England Journal of Medicine · doi:10.1056/nejm198711193172105 · Cited by 1,715 · see citing works
Early Exposure to Anesthesia and Learning Disabilities in a Population-based Birth Cohort
Wilder, R. T., Flick, R. P., Šprung, J., Katusic, S. K., Barbaresi, W. J., Mickelson, C., Gleich, S. J., Schroeder, D. R., Weaver, A. L., & Warner, D. O. (2009) · Anesthesiology · doi:10.1097/01.anes.0000344728.34332.5d · Cited by 1,358 · see citing works
Report of the Second Task Force on Blood Pressure Control in Children—1987
Task Force on Blood Pressure Control in Children (1987) · PEDIATRICS · doi:10.1542/peds.79.1.1 · Cited by 1,149 · see citing works
Report of the second Task Force on Blood Pressure Control in Children―1987
Horan, M. J. (1987) · PEDIATRICS · Cited by 1,127 · see citing works
Davidson, A. J., Disma, N. M., de Graaff, J. C., Withington, D. E., Dorris, L., Bell, G., Stargatt, R., Bellinger, D. C., Schuster, T., Arnup, S. J., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00608-x · Cited by 1,125 · see citing works
Sun, L. S., Li, G., Miller, T. L. K., Salorio, C., Byrne, M. W., Bellinger, D. C., Ing, C., Park, R., Radcliffe, J., Hays, S. R., et al. (2016) · JAMA · doi:10.1001/jama.2016.6967 · Cited by 949 · see citing works
Bhananker, S. M., Ramamoorthy, C., Geiduschek, J. M., Posner, K. L., Domino, K. B., Haberkern, C. M., Campos, J. S., & Morray, J. P. (2007) · Anesthesia & Analgesia · doi:10.1213/01.ane.0000268712.00756.dd · Cited by 717 · see citing works
Long-term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia
Ing, C. H., DiMaggio, C. J., Whitehouse, A., Hegarty, M. K., Brady, J. E., von Ungern-Sternberg, B. S., Davidson, A. J., Wood, A. J. J., Li, G., & Sun, L. S. (2012) · PEDIATRICS · doi:10.1542/peds.2011-3822 · Cited by 605 · see citing works
Isoflurane-induced Neuroapoptosis in the Neonatal Rhesus Macaque Brain
Brambrink, A. M., Evers, A. S., Avidan, M. S., Farber, N. B., Smith, D. J., Zhang, X., Dissen, G. A., Creeley, C. E., & Olney, J. W. (2010) · Anesthesiology · doi:10.1097/aln.0b013e3181d049cd · Cited by 587 · see citing works
Paule, M. G., Li, M., Allen, R. R., Liu, F., Zou, X., Hotchkiss, C. E., Hanig, J. P., Patterson, T. A., Slikker, W., & Wang, C. (2011) · Neurotoxicology and Teratology · doi:10.1016/j.ntt.2011.01.001 · Cited by 570 · see citing works
DiMaggio, C. J., Sun, L. S., Kakavouli, A., Byrne, M. W., & Li, G. (2009) · Journal of Neurosurgical Anesthesiology · doi:10.1097/ana.0b013e3181a71f11 · Cited by 487 · see citing works
Anesthesia and Cognitive Performance in Children: No Evidence for a Causal Relationship
Bartels, M., Althoff, R. R., & Boomsma, D. I. (2009) · Twin Research and Human Genetics · doi:10.1375/twin.12.3.246 · Cited by 368 · see citing works
Pediatric anesthesia morbidity and mortality in the perioperative period
Cohen, M. M., Cameron, C. B., & Duncan, P. G. (1995) · Journal of Clinical Anesthesia · doi:10.1016/0952-8180(95)94739-k · Cited by 366 · see citing works
Stratmann, G., Sall, J. W., May, L. D. V., Bell, J. S., Magnusson, K. R., Rau, V., Visrodia, K., Alvi, R. S., Ku, B., Lee, M. T., et al. (2009) · Anesthesiology · doi:10.1097/aln.0b013e31819c463d · Cited by 356 · see citing works
Pediatric Anesthesia Morbidity and Mortality in the Perioperative Period
Cohen, M. M., Cameron, C. B., & Duncan, P. G. (1990) · Anesthesia & Analgesia · doi:10.1213/00000539-199002000-00005 · Cited by 345 · see citing works
Perioperative Cardiac Arrests in Children between 1988 and 2005 at a Tertiary Referral Center
Flick, R. P., Šprung, J., Harrison, T. E., et al. (2007) · Anesthesiology · doi:10.1097/00000542-200702000-00009 · Cited by 269 · see citing works
Fabres, J. G., Carlo, W. A., Phillips, V. A., Howard, G., & Ambalavanan, N. (2007) · PEDIATRICS · doi:10.1542/peds.2006-2434 · Cited by 254 · see citing works
Head, B. P., Patel, H. H., Niesman, I. R., Drummond, J. C., Roth, D. M., & Patel, P. M. (2009) · Anesthesiology · doi:10.1097/aln.0b013e31819b602b · Cited by 249 · see citing works
Postoperative Mortality in Children After 101,885 Anesthetics at a Tertiary Pediatric Hospital
van der Griend, B. F., Lister, N. A., McKenzie, I., et al. (2011) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e318213be52 · Cited by 242 · see citing works
Briner, A., Nikonenko, I., Roo, M. D., Dayer, A. G., Müller, D., & Vutskits, L. (2011) · Anesthesiology · doi:10.1097/aln.0b013e318221fbbd · Cited by 236 · see citing works
Impact of anaesthetics and surgery on neurodevelopment: an update
Sanders, R. D., Hassell, J. K., Davidson, A. J., Robertson, N. J., & Ma, D. (2013) · British Journal of Anaesthesia · doi:10.1093/bja/aet054 · Cited by 213 · see citing works
(1992) · Archives of Disease in Childhood · doi:10.1136/adc.67.10_spec_no.1221 · Cited by 184 · see citing works
Sanchez, V., Feinstein, S. D., Lunardi, N., Joksovic, P. M., Boscolo, A., Todorovic, S. M., & Jevtović‐Todorović, V. (2011) · Anesthesiology · doi:10.1097/aln.0b013e3182303a63 · Cited by 180 · see citing works
Hypocarbia and Adverse Outcome in Neonatal Hypoxic-Ischemic Encephalopathy
Pappas, A., Shankaran, S., Laptook, A. R., Langer, J., Bara, R., Ehrenkranz, R. A., Goldberg, R. N., Das, A., Higgins, R. D., Tyson, J. E., et al. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2010.10.019 · Cited by 167 · see citing works
Graham, M. R., Brownell, M. D., Chateau, D. G., Drăgan, R., Burchill, C. A., & Fransoo, R. R. (2016) · Anesthesiology · doi:10.1097/aln.0000000000001245 · Cited by 166 · see citing works
Delayed Environmental Enrichment Reverses Sevoflurane-induced Memory Impairment in Rats
Shih, J., May, L. D. V., Gonzalez, H., Lee, E. W., Alvi, R. S., Sall, J. W., Rau, V., Bickler, P. E., Lalchandani, G. R., Yusupova, M., et al. (2012) · Anesthesiology · doi:10.1097/aln.0b013e318247564d · Cited by 154 · see citing works
Infantile Postoperative Encephalopathy: Perioperative Factors as a Cause for Concern
McCann, M. E., Schouten, A. N. J., Dobija, N., Munoz, C., Stephenson, L. L., Poussaint, T. Y., Kalkman, C. J., Hickey, P. R., de Vries, L. S., & Tasker, R. C. (2014) · PEDIATRICS · doi:10.1542/peds.2012-0973 · Cited by 147 · see citing works
FREQUENCY OF CARDIAC ARREST ASSOCIATED WITH ANESTHESIA IN INFANTS AND CHILDREN
Rackow, H., Salanitre, E., & Green, L. T. (1961) · PEDIATRICS · doi:10.1542/peds.28.5.697 · Cited by 133 · see citing works
Ito, H., Yokoyama, I., Iida, H., Kinoshita, T., Hatazawa, J., Shimosegawa, E., Okudera, T., & Kanno, I. (2000) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1097/00004647-200008000-00011 · Cited by 127 · see citing works
The Lower Limit of Cerebral Autoregulation in Children During Sevoflurane Anesthesia
Vavilala, M. S., Lee, L. A., & Lam, A. M. (2003) · Journal of Neurosurgical Anesthesiology · doi:10.1097/00008506-200310000-00003 · Cited by 117 · see citing works
Hoffman, W. E., & Baughman, V. L. (1990) · Anesthesia & Analgesia · doi:10.1213/00000539-199002001-00160 · Cited by 107 · see citing works
Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment
McCann, M. E., & Schouten, A. N. J. (2013) · Pediatric Anesthesia · doi:10.1111/pan.12310 · Cited by 103 · see citing works
Limperopoulos, C., Bassan, H., Kalish, L. A., et al. (2007) · PEDIATRICS · doi:10.1542/peds.2007-0075 · Cited by 80 · see citing works
Isoflurane Impairs Immature Astroglia Development In Vitro: The Role of Actin Cytoskeleton
Lunardi, N., Hucklenbruch, C., Latham, J. R., Scarpa, J. R., & Jevtović‐Todorović, V. (2011) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e31821284e9 · Cited by 61 · see citing works
Resch, B., Neubauer, K., Hofer, N., Resch, E., Maurer, U., Haas, J. G., & Müller, W. (2011) · Early Human Development · doi:10.1016/j.earlhumdev.2011.06.011 · Cited by 59 · see citing works
The effect of anaesthesia on the infant brain
Davidson, A. J. (2016) · Early Human Development · doi:10.1016/j.earlhumdev.2016.09.006 · Cited by 27 · see citing works
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Anesthesia for major surgery in the neonate
Kuan, C. C., & Shaw, S. J. (2020) · Anesthesiology Clinics · doi:10.1016/j.anclin.2019.10.001 · Cited by 26 · see citing works
Wang, Y., Wu, G., Song, J., Song, H., & Chu, Q. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1567386 · Cited by 8 · see citing works
- Authors
- Houck, C. S., & Vinson, A. E.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Houck, Constance S
- Venue
- Archives of Disease in Childhood - Fetal and Neonatal Edition
- Publisher
- BMJ
- Published
- 2017-03-10
- Volume
- 102
- Issue
- 4
- Pages
- F359-F363
- ISSN
- 1359-2998 (ISSN-L)
- 1468-2052
- OpenAlex
- W2593078163
- Cited by
- 46
- References
- 39
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 9 · 2019: 7 · 2018: 6 · 2017: 4
- FWCI
- 2.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Disease in Childhood Fetal & Neonatal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Developmental Neuroscience › Anesthesia and Neurotoxicity Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- neonatal anesthesia, general anesthesia, neurotoxicity, neuronal apoptosis, anesthetic agents, perioperative hypotension, hypocapnia, neurocognitive development, preterm infants, congenital malformations, hemodynamic changes, anesthesia monitoring
- MeSH terms
- Anesthesia Recovery Period, Anesthesia, General, Brain, Developmental Disabilities, Humans, Infant, Newborn, Anesthetics, General, Evidence-Based Medicine
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