Abstract
Background Neonatal encephalopathy with seizures after general anesthesia not occurring in infants
undergoing cardiac or major neurosurgery is very uncommon. An ischemic origin due
to cerebral hypoperfusion from perioperative hypotension has been suggested, but there
is a lack of a consensus definition for intraoperatory hypotension in neonates.
Case Report We report the first case of neonatal encephalopathy with seizures in a neonate with
anorectal malformation. He underwent a colostomy with caudal anesthesia combined with
light general anesthesia. Intraoperative systolic blood pressure and mean blood pressure
values were considered normal. Thirty-two hours after the intervention, the patient
presented electroclinical seizures. Diffusion-weighted imaging showed bilateral involvement
with reduced diffusivity in the watershed areas of the middle cerebral artery and
posterior cerebral artery.
Conclusion Perioperative monitoring of blood pressure is not enough in neonatal surgery. Cerebral
magnetic resonance imaging should be considered in infants with noncardiac congenital
anomalies after neonatal surgery and long-term follow-up is required.
Keywords
encephalopathy - postoperative - hypotension - caudal anesthesia - diffusion-weighted
imaging - neonate
