Editorial Views  |   December 2019
Are There Common Network-level Correlates of the Anesthetized Brain in Infants and Adults?
Author Notes
  • From the Department of Anesthesiology (M.P.P., G.A.M.), the Center for Consciousness Science (M.P.P., G.A.M.), and the Neuroscience Graduate Program (G.A.M.), University of Michigan Medical School, Ann Arbor, Michigan.
  • This editorial accompanies the article on p. 1239.
    This editorial accompanies the article on p. 1239.×
  • Accepted for publication August 19, 2019.
    Accepted for publication August 19, 2019.×
  • Address correspondence to Dr. Mashour: gmashour@umich.edu
Article Information
Editorial / Central and Peripheral Nervous Systems / Pediatric Anesthesia
Editorial Views   |   December 2019
Are There Common Network-level Correlates of the Anesthetized Brain in Infants and Adults?
Anesthesiology 12 2019, Vol.131, 1202-1204. doi:https://doi.org/10.1097/ALN.0000000000002993
Anesthesiology 12 2019, Vol.131, 1202-1204. doi:https://doi.org/10.1097/ALN.0000000000002993
Anesthetic care of infants and children has evolved considerably over the last four decades. In the mid-1980s, infants were undergoing invasive procedures with either no or “light” anesthesia supplemented with a neuromuscular blocking agent. Parents became appalled, which motivated a public outcry and sparked an intense discussion among anesthesia providers on how best to anesthetize infants.1  This led to a paradigm shift in pediatric anesthesiology, with providers recognizing the possibility and consequences of pain in infants undergoing surgery and reconsidering anesthetic regimens accordingly. The pendulum has now swung in the opposite direction, as the conversation in pediatric anesthesia over the last decade has been dominated by neurotoxicity and the potentially detrimental effects of anesthetics in the developing brain, brought into public view by a recent Food and Drug Administration black box warning on anesthetic medications for young children and pregnant women. As every pediatric anesthesia provider will attest, infants and children are not just “little adults,” yet in accomplishing one of the fundamental goals of anesthetic care, methods of titrating anesthetics in infants are based on the same variables used in adult patients (i.e., minimum alveolar concentration values, patient movement, and hemodynamic changes). This is, in part, due to an incomplete understanding of the neurobiologic mechanisms of anesthesia and lack of surrogate markers of unconsciousness in the developing brain. In this issue of Anesthesiology, Pappas et al.2  present an elegant study that begins to inform this current gap in knowledge.