Safety considerations of anesthetic drugs in children

ABSTRACT

Introduction: Great strides have been made in the last twenty years in providing safe anesthesia care for infants and children. Despite a historical record of safety, recent findings have called to question the toxicities of many anesthetic agents. Observations concerning the inherent safety of these agents, their appropriate management in infants, and new findings which suggest overlooked toxicities will be discussed.

Areas covered: A literature search using Pub Med identified journal articles relating to the safety of anesthetic agents in infants and children. From this group, representative classical articles, as well as more recent offerings, were chosen that were germane to the topic of anesthetic drug safety in children.

Expert opinion: Anesthetic agents used in children in the US are generally safe in the short term and are administered to thousands of children daily without demonstrable harm. The question of a deleterious effect of anesthetics on the developing central nervous system when used for long periods and on multiple occasions continues to be open to debate. Conservative elective management of these agents in infants and young children is reasonable until such time as more is known about the toxicities on the central nervous system.

KEYWORDS:

• Pediatric
• drug safety
• general anesthetics
• risk

Article highlights

• Agents used to provide general anesthesia in infants and children have been studied historically in adults. Pharmacokinetic data are less developed for infants and children.

• Safety and efficacy data has been derived largely from years of clinical experience after and, in some instances, concurrent with adult studies.

• Safety concerns regarding issues such as propofol infusion syndrome, malignant hyperthermia, hyperkalemia in infants with occult myopathies, and suspected interference of general anesthetic agents were developed after evaluation of many years of post marketing data.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper as not funded