J Anesth Perioper Med. 2017;4(3):129-138. https://doi.org/10.24015/ebcmed.japm.2017.0024
From Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Correspondence to Dr. Yun Yue at firstname.lastname@example.org.
EBCMED ID: ebcmed.japm.2017.0024 DOI: 10.24015/ebcmed.japm.2017.0024
Aim of review
Early life exposure to general anesthesia in preclinical studies has consistently led to neurodevelopmental deficits later in life. However, the transferability of animal data to humans is questioned, and the published clinical results remained controversial. In this review, we attempt to summarize the most current data in human studies, as well as reveal how the research types have changed over the years.
We searched the PubMed database for the keywords “children” or “pediatric” or “neonatal” or “immature brain” or “neurodevelopment” combined with the keywords “anesthesia neurotoxicity”. High-quality original studies of the past decade were selected and divided into animal experiments, retrospective cohort studies and prospective clinical trials to analyze respectively.
Laboratory studies have suggested that commonly used anesthetic agents produce profound neurotoxic effects. Retrospective cohort studies found mixed results which may be depend on different outcome measures. Some of them suggested anesthetic exposure was association with poor neurodevelopmental outcome, but not causality. Most well-conducted clinical trials including PANDA (General Anesthesia compared to Spinal Anesthesia) and GAS (Pediatric Anesthesia and Neurodevelopment Assessment) suggested encouraging results that there is no significant neurocognitive deficit for single or brief anesthetic exposure early in life. The effect of anesthesia neurotoxicity may be time-dependent which remained to be proved.
A majority of well-designed studies provide some reassurance regarding single or brief anesthetic exposure on immature human brain, but many questions surrounding early anesthesia and cognition remain unanswered. So far, surgeons, anesthesiologists, and parents should be careful, as far as possible to reduce the number and duration of children exposed to anesthetics. Elective surgeries should be delayed to more than 3 years of age. (Funded by the National Natural Science Foundation of China.)
Declaration of Interests
The authors declared no other competing interests.
This work was supported by the National Natural Science Foundation of China Grant 81371199.
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