Advertisement

Pediatric Radiology

, Volume 48, Issue 4, pp 524–530 | Cite as

Non-sedation of the neonate for radiologic procedures

  • Richard B. Parad
Minisymposium: Fetal/neonatal imaging
  • 392 Downloads

Abstract

On Dec. 16, 2016, the U.S. Food and Drug Administration (FDA) released a warning regarding the potential neurotoxicity of anesthesia and sedation agents on the developing brain in children younger than 3 years and in women during their 3rd trimester of pregnancy. These concerns have relevance to the pediatric radiologist who must take into consideration how the child’s state might impact image quality. In this review the author provides background on the special concerns in the potentially highest-risk group, pre-term and term neonates, and provides guidance and rationale for the avoidance of sedation in procedural imaging of the newborn.

Keywords

Anesthesia Brain Food and Drug Administration Magnetic resonance imaging Neonate Neurodevelopment Neurotoxicity 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Goske MJ, Applegate KE, Boylan J et al (2008) The 'Image Gently' campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 38:265–269CrossRefPubMedGoogle Scholar
  2. 2.
    Walters JL, Paule MG (2017) Review of preclinical studies on pediatric general anesthesia-induced developmental neurotoxicity. Neurotoxicol Teratol 60:2–23CrossRefPubMedGoogle Scholar
  3. 3.
    Montana M, Evers A (2017) Anesthetic neurotoxicity: new findings and future directions. J Pediatr 181:279–285CrossRefPubMedGoogle Scholar
  4. 4.
    Rappaport B, Suresh S, Hertz S et al (2015) Anesthetic neurotoxicity — clinical implications of animal models. New Engl J Med 372:796–797CrossRefPubMedGoogle Scholar
  5. 5.
    Sall J (2016) Anesthesia kills brain cells, but what does it mean? Anesthesiology 125:1090–1091CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Shih J, May L, Gonzalez H et al (2012) Delayed environmental enrichment reverses sevoflurane-induced memory impairment in rats. Anesthesiology 116:586–602CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Slikker W, Zou X, Hotchkiss C et al (2007) Ketamine-induced neuronal cell death in the perinatal Rhesus monkey. Toxicol Sci 98:145–158CrossRefPubMedGoogle Scholar
  8. 8.
    Hoffman G, Nowakowski R, Troshynski T et al (2002) Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics 109:236–243CrossRefPubMedGoogle Scholar
  9. 9.
    American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists (2002) Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 96:1004–1017CrossRefGoogle Scholar
  10. 10.
    Committee on Pediatric Anesthesia, American Society of Anesthesiologists (2016) Statement on practice recommendations for pediatric anesthesia http://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/statement-on-practice-recommendations-for-pediatric-anesthesia.pdf. Accessed 22 Sept 2017
  11. 11.
    Mason K (2008) The pediatric sedation service: who is appropriate to sedate, which medications should I use, who should prescribe the drugs, how do I bill? Pediatr Radiol 38:218–224CrossRefGoogle Scholar
  12. 12.
    Monroe K, Beach M, Reindel R et al (2013) Analysis of procedural sedation provided by pediatricians. Pediatr Int 55:17–23CrossRefPubMedGoogle Scholar
  13. 13.
    Allegaert K, van den Anker J (2015) Neonatal drug therapy: the first frontier of therapeutics for children. Clin Pharmacol Ther 98:288–297CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Anderson B, Allegaert K (2010) The pharmacology of anaesthetics in the neonate. Best Pract Res Clin Anaesthesiol 24:419–431CrossRefPubMedGoogle Scholar
  15. 15.
    Kuehn B (2011) FDA considers data on potential risks of anesthesia use in infants, children. JAMA 305:1749CrossRefPubMedGoogle Scholar
  16. 16.
    Martin L (2017) The basic principles of anesthesia for the neonate. Colombian J Anesthesiol 45:54–61CrossRefGoogle Scholar
  17. 17.
    Houck CS, Vinson AE (2017) Anaesthetic considerations for surgery in newborns. Arch Dis Child Fetal Neonatal Ed 102:F359–F363CrossRefPubMedGoogle Scholar
  18. 18.
    Havidich J, Beach M, Dierdorf S et al (2016) Preterm versus term children: analysis of sedation/anesthesia adverse events and longitudinal risk. Pediatrics 137:e20150463CrossRefPubMedGoogle Scholar
  19. 19.
    Krauss B, Green SM (2006) Procedural sedation and analgesia in children. Lancet 367:766–780CrossRefPubMedGoogle Scholar
  20. 20.
    Kaila R, Chen X, Kannikeswaran N (2012) Postdischarge adverse events related to sedation for diagnostic imaging in children. Pediatr Emerg Care 28:796–801CrossRefPubMedGoogle Scholar
  21. 21.
    Mellon R, Simone A, Rappaport B (2007) Use of anesthetic agents in neonates and young children. Anesth Analg 104:509–520CrossRefPubMedGoogle Scholar
  22. 22.
    McCann M, Soriano S (2012) General anesthetics in pediatric anesthesia: influences on the developing brain. Curr Drug Targets 13:944–951CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Arlachov Y, Ganatra R (2012) Sedation/anaesthesia in paediatric radiology. Br J Radiol 85:e1018–e1031CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Slovis T (2011) Sedation and anesthesia issues in pediatric imaging. Pediatr Radiol 41:514–516CrossRefPubMedGoogle Scholar
  25. 25.
    Anand KJS, Hickey PR (1987) Pain and its effects in the human neonate and fetus. N Engl J Med 317:1321–1329CrossRefPubMedGoogle Scholar
  26. 26.
    Delgado J, Toro R, Rascovsky S et al (2014) Chloral hydrate in pediatric magnetic resonance imaging: evaluation of a 10-year sedation experience administered by radiologists. Pediatr Radiol 45:108–114CrossRefPubMedGoogle Scholar
  27. 27.
    Litman R, Soin K, Salam A (2010) Chloral hydrate sedation in term and preterm infants: an analysis of efficacy and complications. Anesth Analg 110:739–746CrossRefPubMedGoogle Scholar
  28. 28.
    Ikonomidou C, Bosch F, Miksa M et al (1999) Blockade of NMDA receptors and apoptotic neurodegeneration in the developing brain. Science 283:70–74CrossRefPubMedGoogle Scholar
  29. 29.
    Jiang Y, Tong D, Hofacer RD et al (2016) Long-term fate mapping to assess the impact of postnatal isoflurane exposure on hippocampal progenitor cell productivity. Anesthesiology 125:1159–1170CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Rappaport B, Mellon R, Simone A et al (2011) Defining safe use of anesthesia in children. New Engl J Med 364:1387–1390CrossRefPubMedGoogle Scholar
  31. 31.
    Davidson AJ, Disma N, de Graaff JC et al (2016) Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet 387:239–250CrossRefPubMedGoogle Scholar
  32. 32.
    Sun L, Li G, Miller T et al (2016) Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA 315:2312–2320CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Pinyavat T, Warner DO, Flick RP et al (2016) Summary of the update session on clinical neurotoxicity studies. J Neurosurg Anesthesiol 28:356–360CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Gleich SJ, Flick R, Hu D et al (2015) Neurodevelopment of children exposed to anesthesia: design of the mayo anesthesia safety in kids (MASK) Study. Contemp Clin Trials 41:45–54CrossRefPubMedGoogle Scholar
  35. 35.
    Chinn G, Russell J, Sall J (2016) Is a short anesthetic exposure in children safe? Time will tell: a focused commentary of the GAS and PANDA trials. Ann Transl Med 4:408CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Filan P, Hunt R, Anderson P et al (2012) Neurologic outcomes in very preterm infants undergoing surgery. J Pediatr 160:409–414CrossRefPubMedGoogle Scholar
  37. 37.
    Flick R, Katusic S, Colligan R et al (2011) Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics 128:e1053–e1061CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Glatz P, Sandin R, Pedersen N et al (2017) Association of anesthesia and surgery during childhood with long-term academic performance. JAMA Pediatr 171:e163470CrossRefPubMedGoogle Scholar
  39. 39.
    Graham M, Brownell M, Chateau D et al (2016) Neurodevelopmental assessment in kindergarten in children exposed to general anesthesia before the age of 4 years. Anesthesiology 125:667–677CrossRefPubMedGoogle Scholar
  40. 40.
    Hansen T, Pedersen J, Henneberg S et al (2011) Academic performance in adolescence after inguinal hernia repair in infancy. Anesthesiology 114:1076–1085CrossRefPubMedGoogle Scholar
  41. 41.
    Istaphanous G, Loepke A (2009) General anesthetics and the developing brain. Curr Opin Anaesthesiol 22:368–373CrossRefPubMedGoogle Scholar
  42. 42.
    Lee B, Hazarika O, Quitoriano G et al (2014) Effect of combining anesthetics in neonates on long-term cognitive function. Int J Dev Neurosci 37:87–93CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Williams R, Black I, Howard D et al (2014) Cognitive outcome after spinal anesthesia and surgery during infancy. Anesth Analg 119:651–660CrossRefPubMedGoogle Scholar
  44. 44.
    Zhang H, Du L, Du Z et al (2015) Association between childhood exposure to single general anesthesia and neurodevelopment: a systematic review and meta-analysis of cohort study. J Anesth 29:749–757CrossRefPubMedGoogle Scholar
  45. 45.
    Psaty BM, Platt R, Altman RB (2015) Neurotoxicity of generic anesthesia agents in infants and children: an orphan research question in search of a sponsor. JAMA 313:1515–1516CrossRefPubMedGoogle Scholar
  46. 46.
    Card E, Wells N (2016) An introduction to the Smart Tots consensus statement on the use of anesthetic and sedative drugs in infants and toddlers. J Perianesth Nurs 31:3–10CrossRefPubMedGoogle Scholar
  47. 47.
    U.S. Food & Drug Administration (2016) FDA drug safety communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women https://www.fda.gov/Drugs/DrugSafety/ucm532356.htm. Accessed 22 Sept 2017
  48. 48.
    U.S. Food & Drug Administration (2016) FDA statement from Dr. Janet Woodcock, director of FDA’s Center for Drug Evaluation and Research, on new safety information on anesthesia use in young children and pregnant women https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm533346.htm. Accessed 22 Sept 2017
  49. 49.
    Brown RE Jr, Agarwal R (2017) AAP responds to FDA warning on anesthesia use in children. AAP News. http://www.aappublications.org/news/2017/01/10/Anesthesia011017. Accessed 2 Oct 2017
  50. 50.
    Andropoulos D, Greene M (2017) Anesthesia and developing brains — implications of the FDA warning. New Engl J Med 376:905–907CrossRefPubMedGoogle Scholar
  51. 51.
    Shimony JS, Smyser CD, Wideman G et al (2016) Comparison of cortical folding measures for evaluation of developing human brain. NeuroImage 125:780–790CrossRefPubMedGoogle Scholar
  52. 52.
    Caperell K, Pitetti R (2009) Is higher ASA class associated with an increased incidence of adverse events during procedural sedation in a pediatric emergency department? Pediatr Emerg Care 25:661–664CrossRefPubMedGoogle Scholar
  53. 53.
    Green S, Mason K (2011) Stratification of sedation risk — a challenge to the sedation continuum. Pediatr Anesth 21:924–931CrossRefGoogle Scholar
  54. 54.
    Shariat M, Mertens L, Seed M et al (2014) Utility of feed-and-sleep cardiovascular magnetic resonance in young infants with complex cardiovascular disease. Pediatr Cardiol 36:809–812CrossRefPubMedGoogle Scholar
  55. 55.
    Edwards A, Arthurs O (2011) Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives? Pediatr Radiol 41:1353–1364CrossRefPubMedGoogle Scholar
  56. 56.
    Windram J, Grosse-Wortmann L, Shariat M et al (2011) Cardiovascular MRI without sedation or general anesthesia using a feed-and-sleep technique in neonates and infants. Pediatr Radiol 42:183–187CrossRefPubMedGoogle Scholar
  57. 57.
    Gale C, Jeffries S, Logan K et al (2012) Avoiding sedation in research MRI and spectroscopy in infants: our approach, success rate and prevalence of incidental findings. Arch Dis Child Fetal Neonatal Ed 98:F267–F268CrossRefPubMedGoogle Scholar
  58. 58.
    Ureta-Velasco N, Martínez-de Aragón A, Moral-Pumarega M et al (2015) Magnetic resonance imaging without sedation in neonates. An Pediatr 82:354–359CrossRefGoogle Scholar
  59. 59.
    Neubauer V, Griesmaier E, Baumgartner K et al (2011) Feasibility of cerebral MRI in non-sedated preterm-born infants at term-equivalent age: report of a single centre. Acta Paediatr 100:1544–1547CrossRefPubMedGoogle Scholar
  60. 60.
    Mathur A, Neil J, McKinstry R et al (2007) Transport, monitoring, and successful brain MR imaging in unsedated neonates. Pediatr Radiol 38:260–264CrossRefPubMedGoogle Scholar
  61. 61.
    Mason K (2010) Sedation trends in the 21st century: the transition to dexmedetomidine for radiological imaging studies. Pediatr Anesth 20:265–272CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Pediatric Newborn MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Department of PediatricsHarvard Medical SchoolBostonUSA

Personalised recommendations