Prenatal and perinatal anesthesia and the long-term cognitive sequelae: a review

Many children have cognitive weaknesses or impairments of uncertain etiology. A variety of gestational and early-life variables contribute to normative neurocognitive development with countless events potentially hindering successful neural development. Recent research suggests that anesthesia has the potential to negatively affect fetal brain development both prenatally and perinatally. Some of the anesthesiology research suggests that under certain circumstances, children may have a heightened risk for attention-deficit hyperactivity disorder, learning disorders, and perhaps other issues. Though there are no prospective studies evaluating neurocognitive function in children after neonatal exposure to anesthetics, there are several retrospective reviews that demonstrate temporary neurological sequelae after prolonged anesthetic exposure in young children and larger studies identifying long-term neurodevelopmental impairment after neonatal surgery and anesthesia. Studies also suggest a heightened vulnerability likely during the first trimester, particularly when neurons are undergoing rapid development. Specifically, heightened vulnerability to cerebral dysfunction tends to be associated with exposure to multiple anesthetic agents, longer duration of exposure, and multiple episodes of exposure to anesthetic agents.