• Allan F Simpao, Isabel R Randazzo, Jesse L Chittams, Nancy Burnham, Marsha Gerdes, Judith C Bernbaum, Tia Walker, Solveig Imsdahl, Aaron G DeWitt, Elaine H Zackai, J William Gaynor, and Andreas W Loepke.
• Departments 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.
• Anesthesiology. 2023 Oct 1; 139 (4): 393404393-404.

BackgroundChildren 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.MethodsA 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.ResultsThe 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).ConclusionsTotal 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.Copyright © 2023 American Society of Anesthesiologists. All Rights Reserved.

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