Education  |   April 2018
Clinical Evidence for Any Effect of Anesthesia on the Developing Brain
Author Notes
  • From the Department of Anesthesia and Pain Management, Royal Children’s Hospital, the Melbourne Children’s Trials Centre, Murdoch Children’s Research Institute, Melbourne, Australia (A.J.D.); and the College of Physicians and Surgeons, Columbia University, New York, New York (L.S.S.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Corresponding articles on pages 693 and 700.
    Corresponding articles on pages 693 and 700.×
  • Submitted for publication February 14, 2017. Accepted for publication October 5, 2017.
    Submitted for publication February 14, 2017. Accepted for publication October 5, 2017.×
  • Address correspondence to Dr. Sun: College of Physicians and Surgeons, Columbia University, CH 4–440 North, 622 West 168th Street, New York, New York 10032. lss4@cumc.columbia.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Central and Peripheral Nervous Systems / Pediatric Anesthesia / Quality Improvement
Education   |   April 2018
Clinical Evidence for Any Effect of Anesthesia on the Developing Brain
Anesthesiology 4 2018, Vol.128, 840-853. doi:10.1097/ALN.0000000000001972
Anesthesiology 4 2018, Vol.128, 840-853. doi:10.1097/ALN.0000000000001972
Abstract

A recent U.S. Food and Drug Administration warning advised that prolonged or repeated exposure to general anesthetics may affect neurodevelopment in children. This warning is based on a wealth of preclinical animal studies and relatively few human studies. The human studies include a variety of different populations with several different outcome measures. Interpreting the results requires consideration of the outcome used, the power of the study, the length of exposure and the efforts to reduce the confounding effects of comorbidity and surgery. Most, but not all, of the large population-based studies find evidence for associations between surgery in early childhood and slightly worse subsequent academic achievement or increased risk for later diagnosis of a behavioral disability. In several studies, the amount of added risk is very small; however, there is some evidence for a greater association with multiple exposures. These results may be consistent with the preclinical data, but the possibility of confounding means the positive associations can only be regarded as weak evidence for causation. Finally, there is strong evidence that brief exposure is not associated with any long term risk in humans.