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Neurodevelopmental Assessment After Anesthesia in Childhood: Review of the Literature and Recommendations

Beers, Sue R. PhD*†; Rofey, Dana L. PhD*†‡; McIntyre, Katie A. MS§

doi: 10.1213/ANE.0000000000000326
Pediatric Neuroscience: Review Article

Preclinical studies have established that anesthesia is toxic to the brain in neonatal animals, but scant research investigates the neurodevelopmental effects of exposure to anesthesia. In this article, we discuss the issue of outcome measurement of children after anesthesia administered between infancy and approximately 4 years of age. Recent studies are reviewed with the goal of understanding the contributions and limitations of the extant literature with respect to neurodevelopmental outcome. A review of school-based information (academic achievement and learning disability characterization), which are most frequently applied to measure cognitive outcome in cohort studies, is provided. The strengths and limitations of this literature is reviewed, followed by a discussion of how future trials investigating neurodevelopmental outcome after anesthesia might be improved by procedures designed specifically to assess the status of the central nervous system. Neuropsychological assessment is described and proposed as a way to increase the validity and sensitivity of forthcoming studies that intend to evaluate the short- and long-term effects of exposure to anesthesia during infancy and early childhood.

From the *Department of Psychiatry, University of Pittsburgh School of Medicine; †Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center; ‡Department of Pediatrics, University of Pittsburgh School of Medicine; and §Traumatic Brain Injury Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Accepted for publication April 23, 2014.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Sue R. Beers, PhD, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213. Address e-mail to

© 2014 International Anesthesia Research Society