Anesthetic-related neurotoxicity in young children: an update

This review examines the recent data, animal and human, reporting an association between early anesthetic exposure, neuronal cell death, and adverse neurocognitive and behavioral outcomes.

Numerous studies have demonstrated that essentially all commonly used anesthetics, when used alone or in combination, enhance neuroapoptosis in developing rodent brains with resultant impairment in learning, memory, and cognition. Recently, these data have been extended to include studies of nonhuman primates also demonstrating neuroapoptosis and long-term cognitive deficits in response to anesthetic exposure. Of additional concern are several retrospective cohort studies of humans that suggest an association between early anesthetic exposure and neurocognitive deficits. Prospective data in humans are lacking and, as such, a causal relationship between anesthetic exposure and developmental outcome remains speculative.

Although the evidence from nonhuman primates and humans is overtly concerning, it lacks clinical verification. There are, at present, no data that would dictate a change in clinical practice in the anesthetic management of infants and children.