title: Cognitive Dysfunction in Children with Heart Disease: The Role of Anesthesia and Sedation.
abstract: As physicians and caregivers of children with congenital heart disease, we are aware of the increasing need for procedures requiring anesthesia. While these procedures may be ideal for medical and cardiac surgical management, the risks and benefits must be assessed carefully. There are well known risks of cardiovascular and respiratory complications from anesthesia and sedation and a potentially under-appreciated risk of neurocognitive dysfunction. Both animal and human studies support the detrimental effects of repeated anesthetic exposure on the developing brain. Although the studies in humans are less convincing of this risk, the Society of Pediatric Anesthesia jointly with SmartTots provided a consensus statement on the use of anesthetic and sedative drugs in infants and toddlers when speaking to families. (www.pedsanesthesia.org; http://smarttots.org/wp-content/uploads/2015/10/ConsensusStatementV910.5.2015.pdf). An excerpt of the statement is "Concerns regarding the unknown risk of anesthetic exposure to your child's brain development must be weighed against the potential harm associated with cancelling or delaying a needed procedure. Each child's care must be evaluated individually based on age, type, and urgency of the procedure and other health factors. This review provides a summary of the current evidence regarding anesthesia-induced neurotoxicity and the developing brain and its implications for children with congenital heart disease.
authors.affiliation: Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif, USA.
authors.forename: Danton
authors.initials: D
authors.lastname: Char
authors.affiliation: Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif, USA.
authors.forename: Chandra
authors.initials: C
authors.lastname: Ramamoorthy
authors.affiliation: Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wise-Faberowski
mesh_terms: D000367:Age Factors; D000768:Anesthesia, General / Q000009:adverse effects*; D018681:Anesthetics, General / Q000009:adverse effects*; D000818:Animals; D001921:Brain / Q000187:drug effects* / Q000254:growth & development / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000503:physiopathology / Q000523:psychology; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007223:Infant; D007231:Infant, Newborn; D023421:Models, Animal; D018570:Risk Assessment; D012307:Risk Factors; D013045:Species Specificity
chemical_list: D018681:Anesthetics, General; D006993:Hypnotics and Sedatives
keywords: Anesthesia Exposure; Children; Congenital Heart Disease; Neurotoxicity