Professor Brian Anderson MB ChB, PhD, FANZCA, FCICM

Professor of Anaesthesiology, The University of Auckland; Paediatric Anaesthetist/Intensivist, Starship Child Health, Auckland, NZ

Brian Anderson is a specialist paediatric anaesthetist and intensivist at Auckland Children's Hospital, New Zealand. A PhD in paediatric clinical pharmacology was completed in 2002.  He is now Professor of Anaesthesiology at Auckland University. He has published over 200 peer-reviewed papers as well as numerous book chapters. He has a special interest in the pharmacokinetic-pharmacodynamic relationships of simple analgesics and maturation aspects of paediatric pharmacology.

He is Associate Editor-in-Chief for the journal Pediatric Anesthesia, Section Editor for Anaesthesia & Intensive Care Medicine and is Editor (along with Cote and Lerman) for the textbook A Practice of Anaesthesia for Infants and Children.

Neuronal Apoptosis and T-Rex 

Sedatives and anaesthetic agents may trigger structural and functional abnormalities through a process known as neuronal apoptosis in the immature brains of human neonates. Data from animal studies, including primates, support these findings. Although this phenomenon has been intensely investigated in anaesthesia, impact of these drugs (GABA agonists and NMDA antagonists such as volatile anaesthetics e.g., sevoflurane, propofol, midazolam, ketamine, and nitrous oxide) in the neonatal or paediatric ICU child remains unknown. Translating animal findings to humans in clinical anaesthesia settings has been difficult; translating findings to the intensive care setting unexplored. Some drugs (opioids, dexmedetomidine) appear less neurotoxic than others.

Some, but not all, human cohort studies show an association between exposure to anaesthesia in infancy or early childhood and later changes in cognitive tests, school performance or risk of developing neurodevelopmental disorders, but the evidence is weak due to multiple confounders. The GAS and PANDA studies support animal data that short exposure is unlikely to cause any neurodevelopmental impact.

The TREX study aims to determine if low-dose sevoflurane/dexmedetomidine/remifentanil anaesthesia is associated with superior neurodevelopmental outcome compared to standard dose sevoflurane anaesthesia in children less than 2 years of age having surgery expected to last 2.5 hours or longer.

References

Sun LS et al. JAMA. 2016; 315(21): 2312-20.

Davidson AJ et al. Lancet. 2016; 387(10015): 239-50.