Unanswered questions of anesthesia neurotoxicity in the developing brain

Purpose of reviewThis article reviews recent advances and controversies of developmental anesthesia neurotoxicity research with a special focus on the unanswered questions in the field both from clinical and preclinical perspectives.Recent findingsObservational cohort studies of prenatal and early childhood exposure to anesthesia have reported mixed evidence of an association with impaired neurodevelopment. Meta-analyses of currently available studies of early childhood exposure to anesthesia suggest that, while limited to no change in general intelligence can be detected, more subtle deficits in specific neurodevelopmental domains including behavior and executive function may be seen. Several studies have evaluated intraoperative blood pressure values and neurocognitive outcomes and have not found an association. Although many animal studies have been performed, taking into consideration other peri-operative exposures such as pain and inflammation may help with translation of results from animal models to humans.SummaryAdvances have been made in the field of developmental anesthetic neurotoxicity over the past few years, including the recognition that anesthetic exposure is associated with deficits in certain cognitive domains but not others. Although the most important question of whether anesthetic agents actually cause long-term neurodevelopmental effects in children has still not been answered, results from recent studies will guide further studies necessary to inform clinical decision-making in children.

Automated summary

This article reviews recent advances and controversies in developmental anesthesia neurotoxicity research, focusing on unanswered questions in both clinical and preclinical perspectives. Studies have reported mixed evidence of prenatal and early childhood exposure to anesthesia being associated with impaired neurodevelopment, with more subtle deficits in specific cognitive domains. Although the question of whether anesthetic agents cause long-term neurodevelopmental effects in children is still unanswered, recent studies provide guidance for further research to inform clinical decision-making in children. Evaluation: 8/10