Anesthesiology

Balanced anesthesia reduces exposure but not neurodevelopmental risk in infants

September 22, 2025

Adjunctive dexmedetomidine–remifentanil (DEX-R), despite reducing sevoflurane exposure, didn't confer measurable neurodevelopmental benefit at 28 to 30 months compared with sevoflurane alone. These findings suggest no short-term neuroprotective advantage for this regimen in pediatric anesthesia.

Study details: A prospective, double-blind, randomized trial enrolled 400 children under 2 years undergoing single, nonrepetitive surgery. Participants received either sevoflurane alone (control) or sevoflurane with DEX-R (DEX-R group). Neurodevelopmental status was assessed at 28 to 30 months using the Korean Leiter International Performance Scale and Child Behavior Checklist. The primary endpoint (full-scale IQ at 5 years) is pending.

Results: Of 343 children completing follow-up, anesthesia duration was similar between groups. The DEX-R group had significantly lower mean end-tidal sevoflurane concentrations (1.8% vs. 2.6%, P < 0.001). However, no significant differences were observed in mean full-scale IQ scores (DEX-R: 102.5 ± 11.5; control: 103.6 ± 11.5; mean difference −1.1, 95% confidence interval, −3.9 to 1.7; P = 0.442) or Child Behavior Checklist scores.

Source:

Ji SH, et al. (2025, October 1). Anesthesiology. Effects of Dexmedetomidine-Remifentanil on Neurodevelopment of Children after Inhalation Anesthesia: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40923823/