When a child goes to the doctor, sometimes sedative and/or anesthetic medications are used during examinations, treatments, and surgeries. Many parents are concerned about the effects of drugs on their child’s nervous system and growth and development. In clinical practice, pediatric anesthesiologists choose sedation and/or anesthesia with the following goals in mind: 1. to protect the safety and interests of the child 2.Reducing the child’s somatic discomfort and pain. 3.Control anxiety, minimize psychological trauma, and try to make the child forget. 4.Control behavior and/or activities to complete the diagnostic (treatment) operation. 5.Safely remove the child from medical supervision. In view of this, many pediatric clinical trauma or non-trauma operations and examinations are actually performed under sedation and/or anesthesia, including ultrasonography, CT (computed tomography) and MRI (magnetic resonance imaging), tracheoscopy, gastroscopy, bone marrow aspiration, deep venipuncture, electroencephalography, electrocardiography, etc. In contrast, adults do not require anesthesia and/or sedation for any of the above common clinical tests. I use the term “sedation and/or anesthesia” rather than anesthesia because sedation and anesthesia use almost identical 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 in anesthesia. It is impossible for a highly skilled anesthesiologist to achieve precise control over the perfect separation of sedation and anesthesia in clinical work. Many parents have questions about whether children (especially newborns) can perceive pain. Often, they ask the doctor, “Can we do it without anesthesia and/or sedation?” It is important to be clear: 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, and without anesthesia and/or sedation, painful experiences and memories of clinical procedures can last a lifetime, causing social and psychological problems in the child, such as violent tendencies. Safety and metabolism of sedative and/or anesthetic drugs The origin of anesthesia can actually be traced back to the invention of “Tsu san san” by Hua Tuo in ancient China, but there is no evidence of the existence of this drug. The second case of anesthesia he administered was in a pediatric patient. Because children have long been the future of society and have been the target of social protection, almost all sedative and/or anesthetic drugs in clinical use have not been clinically tested in children prior to their introduction to the market, thus the history of pediatric anesthesia is not short, but its development lags far behind that of adult anesthesia. Despite the absence of pediatric clinical trials prior to marketing, the vast majority of sedative and/or anesthetic drugs used in adult clinics have been used in pediatric sedation and/or anesthesia, and today, millions of children receive anesthesia and surgery each year. Decades of use have shown that their safety is similar to that of adults. Compared to adults, pediatric sedation and/or anesthesia is administered by a variety of routes, including intravenous, inhalation, rectal, nasal, subcutaneous or intramuscular, and (depending on the method of anesthesia) intrathecal (including sacral), subarachnoid, and nerve block (drug injection around the nerve plexus), with intravenous and inhalation administration being more commonly used in pediatric anesthesia. Regarding the metabolism of sedative and/or anesthetic drugs. The biggest difference between adults and pediatric patients is the “growth and development” process, in which we can see a huge change in height and weight of the pediatric patient, and the same enzymes that metabolize certain sedative and/or anesthetic drugs are also in the process of growth and development. However, the metabolism of sedative and (or) narcotic drugs in children cannot be generalized, children are not shrinking adults, the factors that determine the effects of drugs in children are not only diverse and complex, the absorption, distribution, metabolism and clearance processes of drugs may be different from adults; even if the drug concentration is the same, the strength and nature of the pharmacological response may be different; the types of diseases are also different, some diseases occur only in children, and some diseases have a different course than adults. disease process is not the same as in adults, and the etiology is not the same. However, for different sedative and/or anesthetic drugs due to different metabolic pathways, the development of enzymes that metabolize drugs, the metabolism of some drugs in children may be slowed down, but the metabolism of some drugs may be enhanced, if the dose is calculated according to kilograms of body weight, the dosage of some drugs is greater than that of adults, for example, we commonly use an analgesic drug “remifentanil “and the intravenous anesthetic “isoproterenol”. Will sedative and/or narcotic drugs affect my child’s intelligence? The concern of many parents, “Do narcotic drugs affect children’s intelligence?” The initial origin of the matter is a paper published in 1999, which concluded that the use of NMDA receptor blockers (commonly used ketamine is one of these drugs) increased apoptosis in the brain cells of newborn animals, and in turn affected neurogenesis; then in 2003, another author found that after 6 hours of anesthesia with imipramine, laughing gas and isoflurane (commonly known as cocktail anesthesia) newborn rats A physiological function of the hippocampus (a functional area of the brain associated with learning memory) was impaired in rats and led to spatial cognitive impairment in rats at 4 weeks to 4 months of age. These and subsequent studies quickly generated intense interest in the anesthesiology community and society. Regarding animal experiments, there are several points worth noting: â‘ The doses used are often much larger than clinical (human), for example, ketamine dosage up to 20-100mg/kg, clinical 2mg/kg; isoproterenol dosage up to 10-60mg/kg, clinical 1mg/kg; imipramine dosage up to 9mg/kg or more, clinical commonly used 0.1mg/kg. â‘¡Anesthesia in animal experiments is After anesthesia, nearly half of the animals will die, and the animals that survive may experience a series of complications such as hypoxia and disturbance of the internal environment due to the extreme depth of anesthesia. (3) In humans (mammals), neurogenesis is completed before birth, and only some brain regions are preserved for neuroregenerative functions, one of which is the hippocampus, which is concerned with learning and memory. However, the apoptosis in it is a normal physiological metabolism. To date, no causal relationship between sedation and/or anesthesia-induced apoptosis of brain cells and learning and memory has been found to exist. Human learning and intelligence are influenced by a variety of factors, and the ability to learn is more than just learning mathematics, languages, physics, etc. Moreover, in general, twins live in almost identical environments and it may be more convincing if one undergoes anesthetic surgery and the other does not (of course it is undeniable that even twins have their own learning abilities). Happily, available retrospective analyses confirm no effect of sedation and/or anesthesia. The anesthesia medicine community has long believed that anesthesia causes post-surgical psychiatric disorders in adults, but recent studies have shown that the incidence of psychiatric disorders in hospitalized patients is the same in medical and surgical patients, and please note that medical patients do not generally undergo surgery and anesthesia. In 2007, the FDA Advisory Committee concluded that “based on the available evidence, there is no need to change the current status of clinical anesthesia”; in 2013, experts concluded that “even if (if) anesthesia has a small neurological impact, it would be better to change the patient’s There is an old Chinese saying that “medicine is only as toxic as its ingredients”, which also applies to sedative and/or anesthetic drugs, and in fact some sedative and/or anesthetic drugs, especially In fact, some sedative and/or narcotic drugs, especially analgesic drugs, are usually derived from “drugs”, so most narcotic drugs are “controlled substances”. Possible adverse reactions after sedation and/or anesthesia include allergy, respiratory depression, nausea, vomiting, itching, irritability, chills, etc. Allergies and respiratory depression need to be quickly reported to the healthcare provider; nausea and vomiting are also common after surgery, but most of them will subside over time, and in severe cases (frequent vomiting or vomiting of the heart) need to be brought to the attention of the healthcare provider for timely treatment. Postoperative irritability is common, and children are often extremely uncooperative, but will gradually recover over time. 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. In children with postoperative irritability, parents should be aware of the need to prevent the child from falling out of bed to avoid further injury; warmth should be observed during chills, but warmth does not necessarily eliminate chills. It should be reminded that some children may undergo two surgeries, for example, the left eye and right eye are operated on separately, and the adverse reactions after the two surgeries may be different, which may be related to the anesthetic drugs, the surgical environment, the ward environment, the drugs used, and the food ingested. After sedation and/or anesthesia surgery, the focus should be on whether the child regains consciousness, whether breathing is stable (compared to pre-surgery), and whether the skin color is as normal. In conclusion, postoperative care requires the joint efforts of parents and health care professionals. Children are our future, and we should take good care of them together.