Editorial Views  |   October 2019
GAS, PANDA, and MASK: No Evidence of Clinical Anesthetic Neurotoxicity!
Author Notes
  • From the Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland (L.V.); and Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Boston, Massachusetts (D.J.C.).
  • Accepted for publication May 28, 2019.
    Accepted for publication May 28, 2019.×
  • Address correspondence to Dr. Vutskits: laszlo.vutskits@hcuge.ch
Article Information
Editorial / Central and Peripheral Nervous Systems / Pediatric Anesthesia
Editorial Views   |   October 2019
GAS, PANDA, and MASK: No Evidence of Clinical Anesthetic Neurotoxicity!
Anesthesiology 10 2019, Vol.131, 762-764. doi:https://doi.org/10.1097/ALN.0000000000002863
Anesthesiology 10 2019, Vol.131, 762-764. doi:https://doi.org/10.1097/ALN.0000000000002863
Two decades ago, the possibility that anesthetics could harm the developing brain was identified in rodents.1  This work has been replicated in multiple species, including subhuman primates, raising serious concern in the anesthesia community and leading to a U.S. Food and Drug Administration warning on the use of anesthetic agents in young children.2,3  Heated discussions have divided healthcare providers and policy makers on the risks versus benefits of general anesthesia and surgery in pediatric populations.4,5  The major reason for this long-standing debate is that some human cohort studies have found an association between early exposure to anesthesia and subsequent neurodevelopmental alterations, while others have not.6  Recently, the only prospective clinical trial addressing whether anesthetics contribute to long-term neurodevelopmental delays in children was published in Lancet, and the news is good.7  This multisite randomized controlled trial compared regional and general anesthesia for their effects on neurodevelopmental outcome and apnea in infants. This study, commonly known as the general anesthesia spinal (GAS) trial, included more than 700 children undergoing inguinal hernia repair during early life who were randomized to either sevoflurane-based general or awake-spinal anesthesia.7,8  Both the primary and secondary outcomes of the study demonstrated no association between 1 h of sevoflurane anesthesia in early life and cognitive composite scores at the age 2 yr or full-scale intelligence quotient from the Wechsler Preschool and Primary Scale of Intelligence test at the age of 5 yr when compared to spinal anesthesia.7,8  This clinical trial is consistent with the results of two other recent human studies, Pediatric Anesthesia Neurodevelopment Assessment (PANDA) and Mayo Anesthesia Safety in Kids (MASK), providing strong evidence that a short exposure to general anesthesia at a young age does not result in detectable alterations in neurodevelopmental outcome.9,10