When a child goes to the doctor, sometimes some sedative and/or anesthetic drugs are used during the examination, treatment, or surgery. Many parents worry that the examination or intraoperative drugs will have an impact on the child’s nervous system and growth and development, is this really the case? Professor Zhang Mazhong, Director of the Department of Anesthesiology at Shanghai Children’s Medical Center, will give you an authoritative explanation: The need for sedation and/or anesthesia In clinical practice, pediatric anesthesiologists choose sedation and/or anesthesia, mainly based on the following goals: 1. To protect the safety and interests of the child. 2. 2. To reduce the child’s somatic discomfort and pain. 3, Control anxiety, minimize psychological trauma, and make every effort to make the child forgetful. 4.Control behavior and/or activities to complete diagnostic (therapeutic) operations. 5. To safely remove the child from medical supervision. In view of this, in fact, many pediatric clinical trauma or non-trauma operations and examinations need to be performed under sedation and/or anesthesia, including ultrasonography, CT (computed tomography) and MRI (magnetic resonance imaging), tracheoscopy, gastrointestinal scopes, bone marrow puncture, deep vein puncture, electroencephalography, electrocardiography, etc.. Adults do not require anesthesia and/or sedation for any of these common clinical procedures. About Sedation and/or Anesthesia I have always used the term “sedation and/or anesthesia” rather than anesthesia because sedation and anesthesia use virtually the same drugs. Although there is a clear conceptual distinction between sedation and anesthesia, there is a practical continuity. The change between sedation, especially deep sedation, and general anesthesia lacks clear clinical indications, so that sometimes, although sedated, the patient is actually under anesthesia. Even the most skillful anesthesiologists cannot precisely control the perfect separation of sedation and anesthesia in their clinical work. There are many parents who wonder, “Can children (especially newborns) perceive pain? Often they ask the doctor, “Can we do it without anesthesia and/or sedation?” It should be clear that children, even small infants, can perceive pain and have a series of physiological responses to pain; adverse memories from childhood can affect the child’s future life; without anesthesia and/or sedation, painful experiences and memories of clinical procedures can last a lifetime and cause social and psychological problems, such as a tendency to violence. Safety and metabolism of sedation and/or anesthesia drugs The origin of anesthesia can actually be traced back to the invention of the ancient Chinese drug “Ma zao san Tsu san sen” by Hua Tuo, but there is a lack of evidence for the existence of this drug. 1846 Dr. Morton demonstrated ether anesthesia in the General Anesthesia Hospital of the U.S., and Dr. Long in the U.S. had begun to perform clinical anesthesia before that. In 1846, Dr. Morton demonstrated ether anesthesia at the General Hospital of Anesthesia in the United States, and before that Dr. Long had already begun to perform clinical anesthesia, and the second case of anesthesia he administered was that of a child. Because children, as the future of society, have long been the object of social protection, and almost all sedative and/or anesthetic drugs used in clinical practice have not been clinically tested in children before they were marketed, the history of pediatric anesthesia is not short, but its development has lagged far behind that of adult anesthesia. Despite the absence of pre-market pediatric clinical trials, the vast majority of sedative and/or anesthetic drugs used in adult clinics have been applied to pediatric sedation and/or anesthesia, and today, millions of children undergo anesthesia and surgery each year. Decades of use have shown that their safety profile is similar to that of adults. In contrast to adults, pediatric sedation and/or anesthesia can be administered through a variety of routes, including intravenous, inhalation, rectal, nasal, subcutaneous or intramuscular, and (depending on the method of anesthesia) intrathecal (including sacral), subarachnoid, and neuraxial block (injection of medication into the periphery of a plexus of nerves), with intravenous and inhalation being more commonly used in pediatric anesthesia. Regarding the metabolism of sedative and/or anesthetic drugs. The biggest difference between an adult and a pediatric patient is “growth and development”, a process in which we can see a dramatic change in height and weight of the pediatric patient, as well as the growth and development of the enzymes that metabolize some of the sedative and/or anesthetic drugs. However, the metabolism of sedative and (or) anesthetic drugs in children cannot be generalized, children are not shrunken adults, and the factors determining the effect of drugs in children are not only diversified but also complex, and the absorption, distribution, metabolism, and clearance process of drugs may be different from that of adults; even if the concentration of the drug is the same, the intensity of the pharmacological response and the nature of the drug may be different; and the types of diseases are not the same either, and some of them occur only in children, and some of them are not the same as that of adults. course of the disease is different from that of adults, and the etiology of the disease is different. However, for different sedative and/or anesthetic drugs, due to the metabolic pathway, the development of the enzymes that metabolize the drugs are different, the metabolism of some drugs may be slowed down in children, but the metabolism of some drugs may be enhanced, and if the dose is calculated according to the kilogram of body weight, the dosage of some of the drugs is greater than that of adults, for example, one of the analgesic drugs we commonly use is remifentanil and intravenous anesthetics, and the amount is greater than that of adults. For example, one of our common analgesic drugs “remifentanil” and intravenous anesthetic “isoproterenol”. Will sedative and/or anesthetic drugs affect my child’s intelligence? Many parents are concerned about the question, “Can anesthesia drugs affect a child’s intelligence?” The original origin of the matter is a paper published in 1999, which concluded that the use of NMDA receptor blockers (ketamine, commonly used in clinical practice, belongs to this type of drug) increased apoptosis in the brain cells of newborn animals, and in turn affected the neurological occurrence; then in 2003, another author found that after 6 hours of anesthesia with imipramine, laughing gas and isoflurane (commonly known as a cocktail of anesthesia), the hippocampus (a part of the brain) of the rat was affected by the use of anesthesia. impaired a physiological function of the hippocampus (a functional area of the brain associated with learning memory) and led to spatial cognitive deficits in rats at 4 weeks to 4 months. These and subsequent studies quickly generated intense interest in the anesthesiology community and society, is this really the case? Regarding animal experiments, there are a few points worth noting: ① the dosage used is often much larger than the clinical (human), for example, ketamine dosage of up to 20-100mg/kg, clinical 2mg/kg; isoproterenol dosage of up to 10-60mg/kg, clinical 1mg/kg; imipramine dosage of up to 9mg/kg or more, the clinic commonly used 0, 1mg/kg. ② the anesthesia of animal experiments is a “bad” anesthesia, and it is a “bad” anesthesia. Anesthesia for animal experiments is a kind of “bad” anesthesia, after anesthesia, nearly half of the animals will die, and the animals that survive may experience a series of complications such as hypoxia and internal environment disorders due to extremely deep anesthesia. (3) Neurogenesis in humans (mammals) is completed before birth, and only part of the brain is preserved for neural regeneration, and the hippocampus is one of them, which is related to learning and memory. However, apoptosis in them is part of normal physiological metabolism. To date, no causal relationship between sedation and/or anesthesia-induced apoptosis in the brain and learning and memory has been found to exist. Human learning, intelligence, etc., is influenced by a variety of factors, and the ability to learn is not just about learning math, languages, physics, etc. Furthermore, in general, twins live in almost identical environments, and it may be more convincing if one underwent anesthetic surgery and the other did not (although of course it is undeniable that even twins have their own learning abilities). Happily, there have been retrospective analyses confirming no effect of sedation and/or anesthesia. The anesthesiology medical community has long believed that anesthesia causes post-surgical psychiatric disorders in adults, but more recent studies have shown that the incidence of psychiatric disorders in hospitalized patients is the same for medical and surgical patients, noting that medical patients do not typically undergo surgery and anesthesia. In 2007, a U.S. Food and Drug Administration (FDA) advisory committee concluded that “based on the available evidence, there is no need to change the status quo of clinical anesthesia”; in 2013, expert opinion concluded that “even if (if) anesthesia has a small neurological effect, it would be a mistake to change the patient’s current anesthesia technique or simply not do it at all. Even if (if) anesthesia has a small effect on the nervous system, changing the child’s current anesthetic technique or not doing anesthesia at all could lead to even greater neurological harm”. Adverse effects after sedation and/or anesthesia There is an old Chinese saying that “medicines are three times as poisonous”, which also applies to sedative and/or anesthetic drugs. In fact, some of the sedative and/or anesthetic drugs, especially analgesic drugs, are usually derived from “narcotics”, so most of them are “drugs”. Therefore, most narcotic drugs are “controlled substances”. Adverse effects that may occur after sedation and/or anesthesia include allergies, respiratory depression, nausea, vomiting, itching, irritability, and chills. When a child develops allergies and respiratory depression, it is important to inform the healthcare provider quickly; nausea and vomiting are also common after surgery, but most of them will subside with time; in severe cases (frequent vomiting or vomiting of the heart), it is necessary to bring them to the attention of the healthcare provider for prompt treatment. Itching can also be associated with allergies, and usually does not need to be treated if it is not severe; postoperative irritability is common, and children are often extremely uncooperative, but recover gradually over time; there is a great deal of speculation as to the cause of irritability, but none of it has been confirmed. The transition from one state of consciousness to another is usually accompanied by a change in mood, for example, a child may have a tantrum when waking up in the morning, and the transition from sedation and/or anesthesia to awakening may be similar. Parental care should be taken to prevent the child from falling out of bed, which may cause further injury, and to keep the child warm during chills, although warmth does not necessarily eliminate the chills. It should be reminded that some children may undergo two surgeries, e.g., the left eye and the right eye are operated on separately, and the adverse reactions after the two surgeries may be different, which may be related to the anesthetic medication, surgical environment, hospital room environment, the medication used, and the food ingested. After the sedation and/or anesthesia procedure, the focus should be on whether the child regains consciousness, whether the breathing is stable (compared with before the procedure), and whether the skin color is as normal. In conclusion, postoperative care requires the joint efforts of parents and healthcare professionals. Children are our future and we should take good care of them together.