Authors: Ji, Sang-Hwan et al.
Anesthesiology 143(4):827–834, October 2025. DOI: 10.1097/ALN.0000000000005634
This randomized, double-blind trial enrolled infants <2 years undergoing single, nonrepetitive surgeries to test whether adding dexmedetomidine plus remifentanil (DEX-R) and thereby reducing sevoflurane exposure alters early neurodevelopment versus sevoflurane alone. At 28–30 months, 343 of 400 participants completed assessment. Despite a markedly lower mean end-tidal sevoflurane in DEX-R (1.8% vs 2.6%), there were no differences in cognitive or behavioral outcomes: mean Leiter full-scale IQ ~102–104 in both groups (mean difference −1.1; 95% CI −3.9 to 1.7; P=0.442) and similar Child Behavior Checklist totals. Anesthesia duration was comparable between groups.
Interpretation: In this cohort, adjunct DEX-R that reduced sevoflurane concentration did not improve neurodevelopmental scores at 28–30 months. The primary endpoint is IQ at 5 years; results are pending and will be more definitive for long-term neurodevelopmental safety.
What You Should Know
• Strategy tested: lowering volatile dose with dexmedetomidine + remifentanil did not change 28–30-month cognition/behavior versus sevo alone.
• Safety signal: no early neurodevelopmental harm or benefit detected; confidence intervals exclude any large effect.
• Still to come: the prespecified primary endpoint at 5 years will be critical before changing practice.
• Practical takeaway now: for brief infant surgeries, choosing DEX-R to reduce sevo concentration is unlikely to influence early neurodevelopmental outcomes.
Thank you to Anesthesiology for publishing this important pediatric neurodevelopment trial.