Introduction
In neonatal and infant anesthesia, every milliliter of anesthetic agent matters. These patients have immature organ systems, low body weight, and heightened sensitivity to anesthetic drugs.[1] Even small deviations in anesthetic concentration can lead to significant physiological consequences, including hemodynamic instability, delayed emergence, and respiratory complications.1
Why precision matters
A 2022 meta-analysis of 31 studies involving over 300,000 children revealed that exposure to anesthesia in early childhood, particularly when dosing is imprecise, was associated with significantly worse outcomes across multiple neurodevelopmental domains. Children exposed to anesthesia showed measurable deficits in executive function (SMD −0.20), motor skills (SMD −0.11), language (SMD −0.08), and academic performance (SMD −0.07).[2] Notably, the risk of being diagnosed with a neurodevelopmental disorder was 81% higher (RR 1.81; 95% CI, 1.25–2.61). These findings reinforce the clinical imperative for technologies that ensure accurate anesthetic delivery, especially in neonates and infants whose physiology is highly sensitive to even small dosing deviations.
The challenge: delivering consistency at low flows
In caring for the neonate and pediatric population, inhalational anesthesia often requires low-flow or minimal-flow techniques to preserve heat and humidity, reduce agent consumption, and maintain cardiopulmonary stability.[3] However, these techniques demand vaporizers that can:[4],[5]
- Deliver accurate concentrations of volatile anesthetics at fresh gas flows as low as <500 mL/min.
- Maintain output consistency despite changes in ambient temperature or carrier gas composition.
- Respond quickly to changes in flow or concentration settings.
Traditional vaporizers may not be optimized for such precision at low flows, increasing the risk of under- or over-delivery of anesthetic agents. With its innovative technologies in anesthesia delivery, GE HealthCare’s range of vaporizers are designed to deliver consistent and accurate anesthetic concentrations at low flow rates.* This capability supports neonatal and pediatric inhalational delivery.
The clinical consensus
While specific vaporizer performance standards at low flows are not always detailed in neonatal anesthesia guidelines, the broader clinical consensus emphasizes the importance of minimizing anesthetic exposure in neonates due to concerns about thermoregulation, drug metabolism, hemodynamic instability, and potential impacts on neurodevelopment. International organizations such Open Anesthesia highlight the importance of:[6],[7],[8]
- Minimizing fresh gas flows to reduce heat and moisture loss.
- Avoiding agent overdose by ensuring accurate vaporizer output.
- Monitoring inspired and expired agent concentrations to guide titration and avoid accumulation.
These recommendations underscore the need for vaporization systems that can perform reliably under the unique demands of neonatal and pediatric anesthesia.
Looking ahead
As neonatal and pediatric anesthesia continues to advance, the ability to deliver precise anesthetic concentrations at low flow rates is becoming increasingly important. Technologies like digital vaporizers that maintain accuracy and responsiveness under these conditions support critical clinical goals, including improved thermoregulation, reduced agent consumption, and more stable hemodynamics. Importantly, minimizing unnecessary anesthetic exposure may also help reduce the potential risks associated with neurodevelopmental impact in this vulnerable population. By aligning with evolving best practices and leveraging modern tools, anesthesia teams can better meet the unique physiological and developmental needs of their smallest patients–today and into the future.
References
[1] Specialist neonatal respiratory care for babies born preterm. National Institute for Health and Care Excellence. April 3, 2019. https://www.nice.org.uk/guidance/ng124/chapter/Recommendations.
[2] Reighard C, Junaid S, Jackson WM, et al. Anesthetic Exposure During Childhood and Neurodevelopmental Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(6):e2217427. doi:10.1001/jamanetworkopen.2022.17427
[3] Cui Y, Wang Y, Cao R, Li G, Deng L, Li J. The low fresh gas flow anesthesia and hypothermia in neonates undergoing digestive surgeries: a retrospective before-after study. BMC Anesthesiol. 2020 Sep 3;20(1):223. doi: 10.1186/s12871-020-01140-5. PMID: 32883204; PMCID: PMC7470439.
[4] Polania Gutierrez JJ, Rocuts KR. Anesthesia Vaporizers. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559321/
[5] Glenski T, Narayanasamy S. Low Flow Anesthesia in Pediatric Patients. Society for Pediatric Anesthesia. https://pedsanesthesia.org/spa-one-pagers/low-flow-anesthesia-in-pediatric-patients/
[6] Henry M, Miller C. Temperature Regulation in Pediatric Anesthesia. OpenAnesthesia. Updated June 13, 2023. https://www.openanesthesia.org/keywords/temperature-regulation-in-pediatric-anesthesia/
[7] American Society of Anesthesiologists Committee on Pediatric Anesthesia. Statement on Practice Recommendations for Pediatric Anesthesia. Updated October 13, 2021. https://www.asahq.org/standards-and-practice-parameters/statement-on-practice-recommendations-for-pediatric-anesthesia
[8] Tan, Jonathan (2025). Optimizing Pediatric Anesthesia Care for Neonates and Infants. GE HealthCare, Clinical View. https://clinicalview.gehealthcare.com/article/optimizing-pediatric-anesthesia-care-neonates-and-infants
Disclaimer: Nothing in this material should be used to diagnose or treat any disease or condition. Readers must consult a healthcare professional.
* Not all products or features are available in all markets. Contact your GE HealthCare representative for further details.
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