AMBULATORY ANESTHESIA: Edited by Susan Dabu-BondocClinical update regarding general anesthesia-associated neurotoxicity in infants and childrenGraham, M. Ruth Author Information Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada Correspondence to M. Ruth Graham, MD, FRCP(C), Associate Professor, Department of Anesthesia and Perioperative Medicine, University of Manitoba, AE223- 671 William Avenue, Winnipeg, Manitoba, Canada, R3C 0Z3. Tel: +1 204 787 2560; fax: +204 787 1560; e-mail: [email protected] Current Opinion in Anaesthesiology: December 2017 - Volume 30 - Issue 6 - p 682-687 doi: 10.1097/ACO.0000000000000520 Buy Metrics Abstract Purpose of review The U.S. Federal Drug Administration (FDA) recently released a warning stating that ‘repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains’ (www.fda.gov/ucm582356.htm). The goal of this article is to review the most recent clinical studies which provide evidence that these concerns may be overstated for the majority of healthy young children who require surgery and anesthesia. Recent findings Three large retrospective matched cohort studies published within the past year provide data on a total of 59 814 children exposed to general anesthesia before age 4 (including 30 021 <2 years and 9814 multiple exposure). All three studies independently conclude that neither exposure to anesthesia in children under 2 years of age nor multiple exposures are associated with adverse neurodevelopmental consequences in the patient populations studied. Biological, environmental, and social factors were found to be of far greater import. Summary These findings suggest that anesthetic neurotoxicity is not a major contributory pathway for adverse neurodevelopmental outcomes in the majority of healthy children who require surgery before 3 years of age. Future work should focus on the particular vulnerabilities of the fetus, premature infant, and children with developmental disabilities, major congenital, cardiac or neurological abnormalities not specifically addressed by these studies. Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.