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SmartTots Update Regarding Anesthetic Neurotoxicity in the Developing Brain

Orser, Beverley, A., MD, PhD*,†,‡; Suresh, Santhanam, MD§; Evers, Alex, S., MD

doi: 10.1213/ANE.0000000000002833
General Articles: Special Article

SmartTots (http://smarttots.org/) represents a public–private partnership between the International Anesthesia Research Society and the US Food and Drug Administration. Over the past 7 years, SmartTots has worked in collaboration with various stakeholders to determine whether anesthetic drugs have detrimental effects on the developing brain. SmartTots has funded clinical and preclinical studies, organized meetings, served as a repository of peer-reviewed information, and facilitated the development of consensus-based statements. Here, we report advances in the field of anesthetic neurotoxicity and provide an update on SmartTots’ activities. Clinical studies have provided some reassurance that a brief exposure to anesthetic drugs does not cause overt, persistent cognitive deficits. New recommendations aim to increase the reproducibility and “clinical relevance” of data from studies of laboratory animals. Overall, the field has advanced substantially; however, it remains paramount to definitively resolve whether anesthetic drugs are neurotoxic to the immature brain. The results of SmartTots efforts will either ally unwarranted fears or substantially change pediatric anesthetic practice and prompt studies to identify neuroprotective strategies.

From the *Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Departments of Physiology

Anesthesia, University of Toronto, Toronto, Ontario, Canada

§Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois

Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.

Published ahead of print February 2, 2018.

Accepted for publication November 28, 2017.

Funding: None.

The authors declare no conflicts of interest.

The opinions expressed in this article are those of the authors, not SmartTots or the US Food and Drug Administration (FDA). The authors represent the Board of Trustees of the International Anesthesia Research Society (IARS) on the Executive Council and Scientific Advisory Board of SmartTots.

Reprints will not be available from the authors.

Address correspondence to Beverley A. Orser, MD, PhD, University of Toronto, Room 3318, Medical Sciences Bldg, 1 King’s College Cir, Toronto, Ontario M5S1A8, Canada. Address e-mail to Beverley.Orser@utoronto.ca.

© 2018 International Anesthesia Research Society
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