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Annually, millions of neonates and young infants worldwide are submitted to surgery and general anaesthesia. The safety of providing anaesthesia for these patients has recently been cast into doubt based on a large number of animal studies demonstrating that anaesthetic exposure during a vulnerable period of brain development (ie, brain growth spurt) causes neurodegeneration (neuroapoptosis) and abnormal synaptic development with functional deficits in learning and behaviour later in life.1–4 Emerging robust human data, however, do not support this laboratory evidence but reveal other factors that more importantly impact long-term neurocognition.5–8 The aim of this article is to describe the important perioperative safety issues that matter most to children undergoing surgery and influence outcome in perioperative care.
The conduct of anaesthesia
Perioperative complications are more common in neonates, infants and young children when compared with adults.9 Similarly, it is well known that severe complications in paediatric anaesthesia have a 10 times increased mortality in children than in adults.10 Anaesthesia-related cardiac arrest in infants is reported to be up to 19–24/10 000 anaesthetics, which are several times higher compared with all children undergoing anaesthesia (1–7/10 000 anaesthetics).9 Mortality of cardiac arrest in neonatal anaesthesia is 72%.11
Despite these facts, almost 9 out of 10 non-specialist hospitals continue to provide even complex perioperative care to young children with an annual case load of <100 patients per annum in the developed world.12
Children undergoing general anaesthesia regularly are at risk to endure hypotension, hypocapnia, hyperglycaemia/hypoglycaemia, hypoxaemia and hyponatraemia with the latter due to inadequate perioperative fluid therapy.13–15 Each of these single entities can ultimately affect organ maturation and neurocognitive development in addition to serious perioperative cerebral damage, brain death and/or even death.15–18
A vulnerable patient group combined with surgical stress, inadequate set-up and inexperience of the anaesthesia team will inevitably affect …
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.