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Beyond Anesthesia Toxicity: Anesthetic Considerations to Lessen the Risk of Neonatal Neurological Injury

McCann, Mary Ellen MD*; Lee, Jennifer K. MD; Inder, Terrie MBChB

doi: 10.1213/ANE.0000000000004271
Pediatric Anesthesiology

Infants who undergo surgical procedures in the first few months of life are at a higher risk of death or subsequent neurodevelopmental abnormalities. Although the pathogenesis of these outcomes is multifactorial, an understanding of the nature and pathogenesis of brain injury in these infants may assist the anesthesiologist in consideration of their day-to-day practice to minimize such risks. This review will summarize the main types of brain injury in preterm and term infants and their key pathways. In addition, the review will address key potential pathogenic pathways that may be modifiable including intraoperative hypotension, hypocapnia, hyperoxia or hypoxia, hypoglycemia, and hyperthermia. Each of these conditions may increase the risk of perioperative neurological injury, but their long-term ramifications are unclear.

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts

Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology, Johns Hopkins University, Baltimore, Maryland

Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts.

Published ahead of print 4 September 2019.

Accepted for publication April 9, 2019.

Funding: This work was supported by funding from the National Institutes of Health grants (grant no. 1R01HD081303-01, 1-R01 HD06 1136-01A1), Food and Drug Administration grant (grant FDA-SOL-08-SAFEKIDS-Clin 002-Project 2) and the Thrasher Foundation for M.E.M.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Mary Ellen McCann, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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