Presented as ASA, October 24, 2015

Jurgen C. De Graaff, M.D.,Ph.D., Gijs van Kerckhoven, M.D., Wietze Pasma, D.V.M., Leo Van Wolfswinkel, M.D.,Ph.D.
Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, Netherlands


An increasing number of animal- and human studies indicate a potential harmful effects of general anesthesia during critical stage of neurodevelopment. Experimental and clinical studies emphasize that younger age (< 3 yr), higher dose (>1 MAC) and longer duration (>1 hr) of anesthesia are potential risk factors for anesthetic neurotoxicity. However, the translation of these risk factor to procedures potentially at risk has not been performed yet. Therefore, we tried to identify number and type of procedures potentially at risk for the anesthetic neurotoxicity.


To quantify and to identify the type of procedures potentially at risk for the anesthetic neurotoxicity. From experimental studies we defined that the children younger than 3 years receiving 300%min sevoflurane are at risk.


We analyzed a retrospective cohort study of all patients between 0 and 18 years of age anesthetized between January 1st 2011 and January 1st 2014 selected from the Anesthesia Information and Management system (Anstat/4Kleurenpen) in a specialized pediatric university medical center including all specialisms. We defined the amount of volatile anesthetics per case in %min (e.g. area under the curve) in relation to age and number of patients in a 3D plot.


93.1% (16349/17569) patients received Sevoflurane for maintenance of which 6458 were younger than 3 years. A total of 931/6458 (14.4%) of children under three years received >300% min sevoflurane (Figure 1), mostly for urologic (n= 246), general surgery (n= 172), plastic surgery (n= 126) and cardiodiologic (118) procedures. Even in small age groups there is a considerable amount of children that received a large dose of sevoflurane (Figure 1).


One out of 7 children younger than 3 years undergoing anesthesia is at risk for anesthetic neurotoxicity, however only a minority of children received a considerable dose of anesthetics.