Developing brain in children and anesthesia

ABSTRACT

Neuronal cell death after general anesthesia has been documented in several immature animal models. The possibility of anesthesia-induced neurotoxicity during an uneventful anesthetic in neonates or infants has led to serious questions about the safety of pediatric anesthesia. However, the applicability of animal data to clinical anesthesia remains uncertain. In this review, the evidence of the effects of commonly used anesthetics on neural structures and neurocognitive function in newborn humans and animals. Experimental evidences and human studies were reviewed. A growing number of studies in immature animal models demonstrate degenerative effects of several anesthetics on neuronal structure. Several retrospective reviews evaluating neurocognitive function in children demonstrate temporary neurological sequela after prolonged anesthetic exposure in young children and larger studies identify long-term neurodevelopmental impairment after neonatal surgery and anesthesia. The evidence for anesthesia induced neurodegeneration in animal models is compelling and represent the challenge within the practice of pediatric anesthesiology, however, extends well beyond pediatric anesthesiology because the implicated drugs are widely used in a variety of settings of newborn and young children around the world. No data source until now is complete with this regard to the critical elements necessary to address this question: therefore, further investigations of this phenomenon are imperative both in animals and in young children and governments around the world will be needed to adequately address this critical issue.