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Neurotoxicity of sedative and analgesia drugs in young infants with congenital heart disease: 4‐year follow‐up
Author(s) -
Garcia Guerra Gonzalo,
Robertson Charlene M.T.,
Alton Gwen Y.,
Joffe Ari R.,
Cave Dominic A.,
Yasmin Farzana,
Dinu Irina A.,
Creighton Dianne E.,
Ross David B.,
Rebeyka Ivan M.
Publication year - 2014
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12257
Subject(s) - medicine , chloral hydrate , sedation , sedative , anesthesia , neurocognitive , pediatrics , prospective cohort study , intelligence quotient , anesthetic , perioperative , wechsler adult intelligence scale , surgery , psychiatry , cognition
Summary Objectives/Aim To determine whether sedation/analgesia drugs used before, during, and after infant cardiac surgery are associated with neurocognitive and functional outcomes. Background Some animal models suggest neurotoxic effects of anesthetic drugs on the developing brain; however, potential human effects are unknown. Whether these results can be extrapolated to humans is unknown. Methods/Materials Prospective follow‐up project of all infants ≤6 weeks old having surgery for congenital heart disease between 04/03 and 12/06. Demographic, perioperative, and sedation/analgesia variables were collected. Outcomes at kindergarten age were Wechsler Preschool and Primary Scale of Intelligence‐ III , Beery‐Buktenica Developmental Test of Visual Motor Integration ( VMI ‐V), and General Adaptive Composite ( GAC ) of the Adaptive Behavior Assessment System‐ II . Multivariable linear regression was used to identify predictor variables. Results From 135 infants who underwent heart surgery, 19 died, 17 were excluded, 8 were lost to follow‐up, leaving 91 children for analysis. Multiple linear regression found days on chloral hydrate [3.5 (3.7) days] was associated with lower performance intelligence quotient ( PIQ ) (Effect size −1.03; 95% CI −1.96, −0.10; P = 0.03), and cumulative dose [54.2 (60.3) mg·kg −1 ] of benzodiazepines was associated with lower VMI scores (Effect size −0.07; 95% CI −0.12, −0.01; P = 0.026). No other associations were found between sedation/analgesia variables and full‐scale IQ , PIQ , Verbal IQ , VMI , or GAC . Conclusion Assessment of this cohort at kindergarten age found a small statistically significant association between days on chloral hydrate and PIQ , and benzodiazepine cumulative dose and lower VMI . No other association between sedation/analgesia drugs and outcomes was found.