TOPLINE: 

In children younger than 2 years undergoing surgery under general anesthesia, the addition of dexmedetomidine and remifentanil to sevoflurane did not alter the short-term neurodevelopmental outcomes compared with inhaled sevoflurane alone, although it reduced the requirement of sevoflurane.

METHODOLOGY:

• Researchers reported short-term findings from an ongoing prospective, double-blind trial comparing the neurodevelopmental effects of the inhaled anesthetic sevoflurane alone with those of sevoflurane combined with dexmedetomidine and remifentanil in children undergoing surgery.
• They included 400 children younger than 2 years (mean ages, 11.2-11.5 months) undergoing nonstaged, nonrepetitive surgeries under general anesthesia.
• Children were randomly assigned to receive either sevoflurane alone or sevoflurane combined with dexmedetomidine (1 μg/kg loading dose, followed by 1 μg/kg/h continuous infusion) and remifentanil (0.1-0.2 μg/kg/min); all children received IV acetaminophen at the start of surgery.
• At about 30 months of age, neurodevelopment was assessed using a performance-IQ test and scores obtained from a parent-report questionnaire for behavioral and emotional functioning; the full-scale IQ at 5 years will be reported upon completion of the study.

TAKEAWAY:

• No significant differences were observed in scores of full-scale IQ, Brief IQ, fluid reasoning, or basic visualization between children who received sevoflurane alone and those who received sevoflurane with dexmedetomidine and remifentanil.
• Scores of various aspects of emotional and behavioral functioning, as reported by parents, did not differ significantly between the two groups; measures of language development also showed no significant differences.
• The mean end-tidal sevoflurane concentration was significantly lower in children who received sevoflurane combined with dexmedetomidine and remifentanil than in those who received sevoflurane alone (1.8 vol% vs 2.6 vol%; P < .001).
• The mean duration of surgery was under 50 minutes, and the mean duration of anesthesia was under 80 minutes, with no significant differences between the groups.

IN PRACTICE:

The findings “support existing evidence suggesting that brief anesthetic exposure is unlikely to result in clinically significant neurodevelopmental impairment," the researchers reported. “Although the combination of dexmedetomidine and remifentanil effectively reduced sevoflurane requirements during surgery, it provided no measurable neuroprotective advantages,” they added.

SOURCE:

This study was led by Sang-Hwan Ji, MD, PhD, of Seoul National University Hospital in South Korea. It was published online on September 9, 2025, in Anesthesiology.

LIMITATIONS: 

Children who needed additional anesthesia during follow-up were not included, potentially introducing selection bias. Only one tool was used to assess intelligence at baseline. This study lacked comparison with a group of children who were not anesthetized.

DISCLOSURES:

This study received support from the National Research Foundation of Korea. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.