Anaesthesiologic and Surgical Perspectives of Patients Born with Esophageal Atresia: The knife cuts both ways

We found that neonates undergoing primary esophageal atresia repair suffer great metabolic derangements, such as acidosis, hypercapnia and hypoxia. These are all risk factors for the developing brain. In addition to these possibly neurotoxic derangements, putative neurotoxic anesthetics are used in this patient population. We found that, in animal studies, dexmedetomidine has neuroprotective effects when added to these commonly used anesthetics. There are no data on the neurotoxic effects of dexmedetomidine in humans. According to our survey study, dexmedetomidine is increasingly used in the field of pediatric anesthesiology all over the world, with satisfying results. We aimed to assess the long-term neurodevelopment of patients born with esophageal atresia. We found that they undergo a median number 4 procedures requiring general anesthesia, mainly in the first two years of life. We found that patients born with esophageal atresia suffer both impairment of motor function and of cognitive development. The number of procedures the patients undergo is a risk factor for impaired neurodevelopmental outcome at 5 years of age. In addition to this, the number of days of postoperative endotracheal intubation is also a risk factor for impaired neurodevelopment. By monitoring the brain during general anesthesia, we might be able to gain more insight into the events that occur in the brain. However, the neuromonitoring devices that are currently available for pediatric use lack specificity and the data are not related to clinical outcome or prognosis.

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