4^th International Anesthesia and Pain Medicine Conference

Concern has been raised on the potential deleterious neurocognitive effects of general anesthesia during infancy and early life. Although there are no definitive data to prove this effect, the neonatal and infancy period has been suggested to be the most vulnerable period, and some studies observed an association between exposure to general anesthesia as an infant, and later neurobehavioral problems in childhood. The potential neurocognitive effects of various general anesthetic agents have been demonstrated in laboratory animals and suggested from retrospective clinical trials. The anesthetic agents identified as possible neurotoxins include either γ-amino-butyric-acid (GABA) agonists including the volatile anesthetic agents, benzodiazepines, barbiturates or N-methyl-D-aspartate (NMDA) antagonists such as ketamine. Although regional anesthesia is an acceptable alternative, many surgical procedures may not be amenable to regional anesthesia. Dexmedetomidine and remifentanil on the

other hand, seem to be spared of such controversy, however limited data are available regarding their combined use during surgery in infants and Anesthesia. We herein present a case of a 3 month 3 week old infant who presented for examination under anesthesia of bilateral ears as well as Posterior Sagittal Anorectoplasty for anorectal malformation, for which general

anesthesia was provided by using a combination of remifentanil and dexmedetomidine.