SmartTots Update Regarding Anesthetic Neurotoxicity in the Developing Brain

This special article is a relevant update and summary of the current issues in the field of anaesthetic neurotoxicity. This group of authors highlight well the issues facing paediatric anaesthetists since the FDA released their statement in 2016. The warning states that ‘repeated or lengthy use of general anaesthetic and sedation drugs during surgeries in children younger than 3 years or pregnant women during their third trimester may affect the development of children’s brains’. The evidence though from human studies that informed the FDA warning is far less compelling and unfortunately ‘no single randomised controlled clinical trial will provide the answer to this central question because of various confounding factors’. Of note the General Anaesthesia Compared to Spinal Anaesthesia trial suggests that a short exposure to a general anaesthetic drug does not cause persistent cognitive impairment. More definitive answers will be available when primary outcomes at the age 5 are reported later in 2018. The authors remark on the other factors that must be taken into consideration such as hypotension and hypoxia when attributing neurotoxicity to anaesthetic agents.

Take home messages

The authors rightly point out that general anaesthesia is an essential component of paediatric care. The most recent evidence suggests that a single brief exposure to a general anaesthetic does not cause overt neurocognitive deficits in either neonatal laboratory animals or human infants. However, it is still too early to conclude whether anaesthetic drugs administered early in life causes harm. This is a good opportunity for us to educate our surgical colleagues about this issue as well.

Reviewed by: Su May Koh