Key result
Combined dexmedetomidine, remifentanil, and epidural anesthesia successfully supports thoracotomy in a neonate.
Case Report (n=1)
This case report describes the feasibility of using dexmedetomidine and remifentanil for general anesthesia in a neonate, potentially avoiding the deleterious neurocognitive effects associated with other anesthetic agents.
Limited data on dexmedetomidine-opioid combinations in neonates leaves open neurocognitive safety questions; prospective trials required before practice change.
Based on animal data, concern has been expressed regarding the potential deleterious neurocognitive effects of general anesthesia during infancy and early life. Although there are no definitive data to prove this effect, the neonatal period has been suggested to be the most vulnerable period. While various inhaled and intravenous anesthetic agents have been implicated, dexmedetomidine and the opioids may be devoid of such effects. However, there are limited data regarding the combination of these agents during neonatal surgery and anesthesia. We present the use of these agents in combination with epidural anesthesia for postoperative analgesia in a 1-day-old neonate during thoracotomy and excision of a congental cystic adenomatoid malformation. Previous reports of the use of this unique combination of agents are reviewed and their role in this scenario discussed.
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Cappuccio et al. (2018) conducted a case report in Congenital cystic adenomatoid malformation (n=1). Dexmedetomidine and remifentanil with epidural anesthesia was evaluated. General anesthesia with dexmedetomidine and remifentanil combined with epidural anesthesia was successfully used in a 1-day-old neonate undergoing thoracotomy.
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