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Update on developmental anesthesia neurotoxicity

Vutskits, Laszloa,b; Davidson, Andrewc,d

Current Opinion in Anaesthesiology: June 2017 - Volume 30 - Issue 3 - p 337–342
doi: 10.1097/ACO.0000000000000461
PEDIATRIC ANESTHESIA: Edited by Lynne R. Ferrari
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Purpose of review Adverse long-term impact of general anesthesia on the developing brain is a widely discussed and controversial issue with potential public health relevance. The goal of this article is to give insights into the most recent experimental and clinical observations aimed to advance our understanding in this field.

Recent findings Recent investigations demonstrate long-term behavioral consequences of early-life anesthesia exposure in nonhuman primates under experimental conditions that are translationally relevant to human clinical practice. Converging evidence from rodent experiments strongly suggest that anesthetics exert developmental stage-dependent and context-dependent impact on developing neuronal circuitry and, therefore, may induce lasting changes in neuronal plasticity. Although three recent population-based human studies found a strong evidence for small increase in risk, the two most robust studies (General Anaesthesia compared to Spinal anaesthesia trial and Pediatric Anesthesia Neurodevelopment Assessment) did not find an association between brief anesthesia exposure and poor neurodevelopmental outcome.

Summary Experimental data with reasonable translational relevance suggest that early-life exposure to general anesthetics can induce lasting behavioral and cognitive deficits. In contrast, human studies provide, at best, mixed evidence about developmental anesthesia neurotoxicity. Future research, both experimental and human, is needed to clarify this important issue.

aDepartment of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva

bDepartment of Basic Neurosciences, University of Geneva Medical School, Geneva, Switzerland

cDepartment of Anaesthesia, Royal Children's Hospital

dMelbourne Children's Trials Centre, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia

Correspondence to Laszlo Vutskits, Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland. Tel: +41 79 55 33 462; e-mail: laszlo.vutskits@unige.ch

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