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What Next After GAS and PANDA?

Ing, Caleb MD, MS*; Rauh, Virginia A. ScD; Warner, David O. MD; Sun, Lena S. MD*,§

Journal of Neurosurgical Anesthesiology: October 2016 - Volume 28 - Issue 4 - p 381–383
doi: 10.1097/ANA.0000000000000350
Departments: Supplement: Proceedings of the Fifth PANDA Symposium on “Anesthesia and Neurodevelopment in Children”

On April 16 and 17, 2016, the Fifth biennial Pediatric Anesthesia & Neurodevelopment Assessment (PANDA) symposium was convened at the Morgan Stanley Children’s Hospital of New York at Columbia University Medical Center. During the symposium, experts in the fields of anesthesiology, neuropsychology, and epidemiology were convened in a small group session to determine the level of confidence in the current clinical evidence and the next steps in anesthetic neurotoxicity clinical research. Among the participants in the discussion, there remained a lack of consensus on whether anesthetic exposure causes long-term neurodevelopmental deficits in children based on the current evidence. This causal relationship between anesthesia exposure and neurodevelopmental deficit is difficult to establish using observational data, and current and future clinical trials are critical for answering this question. It was, however, recognized that the continuum of data that is seen in studies of other toxic environmental exposures, such as lead poisoning, has not been established in the anesthetic neurotoxicity literature, specifically regarding the timing of the exposure, the dose effects, contributing perioperative conditions, or vulnerable populations. As a result, these questions may need to be addressed in observational studies to guide future clinical trials.

Departments of *Anesthesiology

§Pediatrics, Columbia University College of Physicians and Surgeons

Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Medical Center, New York, NY

Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN

Supported by National Institutes of Health grant number K08HS022941.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ.

C.I. is supported by the Agency for Healthcare Research and Quality (AHRQ) under award number K08HS022941. The remaining authors have no funding sources to disclose.

Address correspondence to: Caleb Ing, MD, MS, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622W. 168th St., BHN 4-440, New York, NY 10032 (e-mail:

Received July 8, 2016

Accepted July 11, 2016

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