{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T11:34:27Z","timestamp":1785584067896,"version":"3.56.0"},"reference-count":24,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,3,1]]},"abstract":"<jats:p>We report on 6 infants who underwent elective surgery and developed postoperative encephalopathy, which had features most consistent with intraoperative cerebral hypoperfusion. All infants were &amp;lt;48 weeks\u2019 postmenstrual age and underwent procedures lasting 120 to 185 minutes. Intraoperative records revealed that most of the measured systolic blood pressure (SBP) values were &amp;lt;60 mm\u2009Hg (the threshold for hypotension in awake infants according to the Pediatric Advanced Life Support guidelines) but that only 11% of the measured SBP values were &amp;lt;1 SD of the mean definition of hypotension (&amp;lt;45 mm\u2009Hg) as reported in a survey of members of the Society for Pediatric Anesthesia in 2009. Four infants also exhibited prolonged periods of mild hypocapnia (&amp;lt;35 mm\u2009Hg). One infant did not receive intraoperative dextrose. All infants developed new-onset seizures within 25 hours of administration of the anesthetic, with a predominant cerebral pathology of supratentorial watershed infarction in the border zone between the anterior, middle, and posterior cerebral arteries. Follow-up of these infants found that 1 died, 1 had profound developmental delays, 1 had minor motor delays, 2 were normal, and 1 was lost to follow-up. Although the precise cause of encephalopathy cannot be determined, it is important to consider the role that SBP hypotension (as well as hypoglycemia, hyperthermia, hyperoxia, and hypocapnia) plays during general anesthesia in young infants in the development of infantile postoperative encephalopathy. Our observations highlight the lack of evidence-based recommendations for the lower limits of adequate SBP and end-tidal carbon dioxide in anesthetized infants.<\/jats:p>","DOI":"10.1542\/peds.2012-0973","type":"journal-article","created":{"date-parts":[[2014,2,11]],"date-time":"2014-02-11T02:11:16Z","timestamp":1392084676000},"page":"e751-e757","source":"Crossref","is-referenced-by-count":135,"title":["Infantile Postoperative Encephalopathy: Perioperative Factors as a Cause for Concern"],"prefix":"10.1542","volume":"133","author":[{"given":"Mary Ellen","family":"McCann","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology, Perioperative and Pain Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.N.J.","family":"Schouten","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Intensive Care and Emergency Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Dobija","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shand Hospital and University of Florida, Gainesville, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Munoz","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Perioperative and Pain Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianne","family":"Stephenson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina Y.","family":"Poussaint","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.J.","family":"Kalkman","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Intensive Care and Emergency Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Hickey","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Perioperative and Pain Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda S.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Neonatology, Intensive Care and Emergency Medicine, University Medical Center, Utrecht, Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Tasker","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Perioperative and Pain Medicine,"},{"name":"Neurology, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2014,3,1]]},"reference":[{"issue":"2","key":"2021120903531652700_B1","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/00000542-200702000-00009","article-title":"Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center: a study of 92,881 patients.","volume":"106","author":"Flick","year":"2007","journal-title":"Anesthesiology"},{"issue":"10","key":"2021120903531652700_B2","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/j.braindev.2009.11.011","article-title":"Unexpected neurological sequelae following propofol anesthesia in infants: three case reports.","volume":"32","author":"Meyer","year":"2010","journal-title":"Brain Dev"},{"issue":"5","key":"2021120903531652700_B3","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1111\/j.0001-5172.2004.0376b.x","article-title":"Postoperative seizures after sevoflurane anesthesia in a neonate.","volume":"48","author":"Hsieh","year":"2004","journal-title":"Acta Anaesthesiol Scand"},{"issue":"2","key":"2021120903531652700_B4","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/j.1365-2044.1966.tb02604.x","article-title":"Convulsions associated with halothane anaesthesia. 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