{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:20:44Z","timestamp":1760145644558,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,18]],"date-time":"2024-08-18T00:00:00Z","timestamp":1723939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The impact of anesthetic agents on memory and cognitive function following general anesthesia is of great interest, particularly regarding their effects on the developing pediatric brain. While numerous studies have examined the relationship between anesthetic drugs and brain function, research focusing on early cognitive function following sedation remains limited. Materials and Methods: This study was a prospective, randomized controlled trial involving 148 pediatric patients scheduled for hematological procedures, specifically bone marrow aspiration (BMA) and intrathecal chemotherapy (ITC). Patients were divided into two groups based on the primary anesthetic used: the inhalational sedation group (IHG), in which sevoflurane was used, and the intravenous sedation group (IVG), which received propofol infusion. Apart from the main anesthetic agent, all sedation methods were consistent across both groups. A cognitive function test administered before sedation involved memorizing four distinct images, each associated with a different number. Then, the patients were asked to identify the omitted image upon awakening in the recovery room. Herein, this pre- vs. post-sedation test is called the early recognition assessment (ERA) tool. The primary outcome was the correct response rate after sedation for the two groups. Secondary outcomes included the sedation score, the behavior response score, and the correct response rates according to the number of sedation procedures. Results: This study included 130 patients in the final analysis, with 74 originally assigned to each group. The initial cognitive assessment revealed no significant difference in performance between the anesthetic agents. In addition, no differences were observed in the rates of correct responses or post-sedation scores after repeated procedures. However, the IVG demonstrated higher behavior response scores compared to the IHG. Conclusions: There were no significant differences in the rates of correct responses using the ERA tool between the two groups, irrespective of the number of sedation procedures performed. While some differences were noted in preoperative, intraoperative, and post-anesthesia care, these did not significantly impact the cognitive outcomes measured.<\/jats:p>","DOI":"10.3390\/medicina60081342","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T03:43:28Z","timestamp":1724039008000},"page":"1342","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Cognitive Function after Deep Sedation Using Different Anesthetic Agents in Pediatric Patients: A Prospective, Randomized Controlled Trial"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1426-4651","authenticated-orcid":false,"given":"Min Suk","family":"Chae","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9634-5120","authenticated-orcid":false,"given":"Hyun Jung","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e59525","DOI":"10.7554\/eLife.59525","article-title":"Recovery of consciousness and cognition after general anesthesia in humans","volume":"10","author":"Mashour","year":"2021","journal-title":"elife"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.jalz.2019.06.4949","article-title":"Cognitive function after surgery with regional or general anesthesia: A population-based study","volume":"15","author":"Sprung","year":"2019","journal-title":"Alzheimers Dement."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2336985","DOI":"10.1001\/jamanetworkopen.2023.36985","article-title":"Postsurgery Subjective Cognitive and Short-Term Memory Impairment Among Middle-Aged Chinese Patients","volume":"6","author":"Yang","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"454","DOI":"10.4103\/sja.SJA_651_19","article-title":"Short-term memory impairment in patients undergoing general anesthesia and its contributing factors","volume":"14","author":"Amiri","year":"2020","journal-title":"Saudi J. Anaesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1097\/ALN.0b013e3181d692c2","article-title":"Implicit memory formation during routine anesthesia in children: A double-masked randomized controlled trial","volume":"112","author":"Pham","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_6","first-page":"Cd012317","article-title":"Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery","volume":"8","author":"Miller","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","first-page":"1623","article-title":"[Effect of propofol and inhalation anesthesia on postoperative cognitive dysfunction in the elderly: A meta-analysis]","volume":"32","author":"Xu","year":"2012","journal-title":"Nan Fang Yi Ke Da Xue Xue Bao"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Broad, K.D., Hassell, J., Fleiss, B., Kawano, G., Ezzati, M., Rocha-Ferreira, E., Hristova, M., Bennett, K., Fierens, I., and Burnett, R. (2016). Isoflurane Exposure Induces Cell Death, Microglial Activation and Modifies the Expression of Genes Supporting Neurodevelopment and Cognitive Function in the Male Newborn Piglet Brain. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166784"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.freeradbiomed.2024.02.017","article-title":"Single exposure to anesthesia\/surgery in neonatal mice induces cognitive impairment in young adult mice","volume":"214","author":"Zhou","year":"2024","journal-title":"Free Radic. Biol. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9018624","DOI":"10.1155\/2020\/9018624","article-title":"Resveratrol Mitigates Sevoflurane-Induced Neurotoxicity by the SIRT1-Dependent Regulation of BDNF Expression in Developing Mice","volume":"2020","author":"Tang","year":"2020","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.clinthera.2021.01.024","article-title":"Anesthesia and the Developing Brain: A Review of Sevoflurane-induced Neurotoxicity in Pediatric Populations","volume":"43","author":"Apai","year":"2021","journal-title":"Clin. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s00213-006-0402-7","article-title":"Effects of midazolam on explicit vs implicit memory in a pediatric surgery setting","volume":"188","author":"Stewart","year":"2006","journal-title":"Psychopharmacology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/ANA.0000000000000541","article-title":"Early Developmental Exposure to Repetitive Long Duration of Midazolam Sedation Causes Behavioral and Synaptic Alterations in a Rodent Model of Neurodevelopment","volume":"31","author":"Xu","year":"2019","journal-title":"J. Neurosurg. Anesthesiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e0105","DOI":"10.1097\/CCE.0000000000000105","article-title":"Potential Neurodevelopmental Effects of Pediatric Intensive Care Sedation and Analgesia: Repetitive Benzodiazepine and Opioid Exposure Alters Expression of Glial and Synaptic Proteins in Juvenile Rats","volume":"2","author":"Zven","year":"2020","journal-title":"Crit. Care Explor."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1177\/08850666231210261","article-title":"Exposure to Sedation and Analgesia Medications: Short-term Cognitive Outcomes in Pediatric Critical Care Survivors with Acquired Brain Injury","volume":"39","author":"Drury","year":"2024","journal-title":"J. Intensive Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1213\/ANE.0000000000001544","article-title":"Recent Insights into Molecular Mechanisms of Propofol-Induced Developmental Neurotoxicity: Implications for the Protective Strategies","volume":"123","author":"Bosnjak","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.neulet.2012.12.033","article-title":"Repeated exposure to propofol potentiates neuroapoptosis and long-term behavioral deficits in neonatal rats","volume":"534","author":"Yu","year":"2013","journal-title":"Neurosci. Lett."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.brainresbull.2021.01.007","article-title":"Repeated exposure to propofol in the neonatal period impairs hippocampal synaptic plasticity and the recognition function of rats in adulthood","volume":"169","author":"Wan","year":"2021","journal-title":"Brain Res. Bull."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1200\/JCO.23.01989","article-title":"Impact of Propofol Exposure on Neurocognitive Outcomes in Children with High-Risk B All: A Children\u2019s Oncology Group Study","volume":"42","author":"Alexander","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e22181","DOI":"10.1002\/syn.22181","article-title":"Genistein attenuates cognitive deficits and neuroapoptosis in hippocampus induced by ketamine exposure in neonatal rats","volume":"75","author":"Li","year":"2021","journal-title":"Synapse"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wu, X., Wen, G., Yan, L., Wang, Y., Ren, X., Li, G., Luo, Y., Shang, J., Lu, L., and Hermenean, A. (2024). Ketamine administration causes cognitive impairment by destroying the circulation function of the glymphatic system. Biomed. Pharmacother., 175.","DOI":"10.1016\/j.biopha.2024.116739"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.toxlet.2013.03.030","article-title":"Developmental neurotoxicity of ketamine in pediatric clinical use","volume":"220","author":"Dong","year":"2013","journal-title":"Toxicol. Lett."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"eaav3801","DOI":"10.1126\/sciadv.aav3801","article-title":"Propofol-induced deep sedation reduces emotional episodic memory reconsolidation in humans","volume":"5","author":"Kroes","year":"2019","journal-title":"Sci. Adv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s10877-018-0134-3","article-title":"Computerized tests to evaluate recovery of cognitive function after deep sedation with propofol and remifentanil for colonoscopy","volume":"33","author":"Borrat","year":"2019","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1007\/s12035-020-02161-4","article-title":"Neonatal Sevoflurane Exposure Impairs Learning and Memory by the Hypermethylation of Hippocampal Synaptic Genes","volume":"58","author":"Fan","year":"2021","journal-title":"Mol. Neurobiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1213\/ane.0b013e318172ba0a","article-title":"Subanesthetic doses of propofol induce neuroapoptosis in the infant mouse brain","volume":"106","author":"Cattano","year":"2008","journal-title":"Anesth. Analg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/ALN.0000000000000477","article-title":"Long-term effects of single or multiple neonatal sevoflurane exposures on rat hippocampal ultrastructure","volume":"122","author":"Amrock","year":"2015","journal-title":"Anesthesiology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1017\/S2040174424000059","article-title":"Anaesthesia and brain development: A review of propofol-induced neurotoxicity in pediatric populations","volume":"15","author":"Zhang","year":"2024","journal-title":"J. Dev. Orig. Health Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.ajog.2017.08.107","article-title":"Food and Drug Administration warning on anesthesia and brain development: Implications for obstetric and fetal surgery","volume":"218","author":"Olutoye","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Zhou, Y., Tan, S., Xu, C., and Ma, J. (2023). Role of posttranslational modifications in memory and cognitive impairments caused by neonatal sevoflurane exposure. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1113345"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.neuroscience.2019.09.024","article-title":"High-dose Propofol Anesthesia Reduces the Occurrence of Postoperative Cognitive Dysfunction via Maintaining Cytoskeleton","volume":"421","author":"Ma","year":"2019","journal-title":"Neuroscience"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4097\/kjae.2011.60.2.73","article-title":"Mechanism of emergence agitation induced by sevoflurane anesthesia","volume":"60","author":"Kim","year":"2011","journal-title":"Korean J. Anesthesiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s40272-016-0201-5","article-title":"Emergence Delirium in Pediatric Anesthesia","volume":"19","author":"Moore","year":"2017","journal-title":"Paediatr. Drugs"},{"key":"ref_34","first-page":"495","article-title":"Current Evidence-Based Practice for Pediatric Emergence Agitation","volume":"87","author":"Hoch","year":"2019","journal-title":"AANA J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/pan.14819","article-title":"Incidence of emergence agitation in children undergoing sevoflurane anesthesia compared to isoflurane anesthesia: An updated systematic review and meta-analysis","volume":"34","author":"Farag","year":"2024","journal-title":"Paediatr. Anaesth."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1342\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:38:29Z","timestamp":1760110709000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,18]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["medicina60081342"],"URL":"https:\/\/doi.org\/10.3390\/medicina60081342","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2024,8,18]]}}}