Key result
Modifiable intraoperative factors including hypotension, hypocapnia, hypoxia, hypoglycemia, and hyperthermia may increase the risk of perioperative neurological injury in infants.
Why the study?
Infants undergoing surgery in early life face higher risks of death or neurodevelopmental abnormalities, and understanding brain injury mechanisms may help anesthesiologists minimize these risks.
Understanding and modifying intraoperative physiological parameters may help anesthesiologists minimize the risk of perioperative neurological injury in neonates.
May prompt closer intraoperative monitoring in neonates; leaves open whether targeted interventions reduce injury.
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.
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McCann et al. (2019) conducted a review in Neonatal Neurological Injury. Anesthetic management of modifiable pathogenic pathways was evaluated. Modifiable intraoperative factors including hypotension, hypocapnia, hypoxia, hypoglycemia, and hyperthermia may increase the risk of perioperative neurological injury in infants.
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