Does General Anesthesia Have Detrimental Effects on Immature Human Brain

Abstract

Aim of review: Early life exposure to general anesthesia in preclinical studies has consistently led to neurodevelopmental deficits later in life. However, the transferability of animal data to humans is questioned, and the published clinical results remained controversial. In this review, we attempt to summarize the most current data in human studies, as well as reveal how the research types have changed over the years.Method: We searched the PubMed database for the keywords "children" or "pediatric" or "neonatal" or "immature brain" or "neurodevelopment" combined with the keywords "anesthesia neurotoxicity". High-quality original studies of the past decade were selected and divided into animal experiments, retrospective cohort studies and prospective clinical trials to analyze respectively.Recent findings: Laboratory studies have suggested that commonly used anesthetic agents produce profound neurotoxic effects. Retrospective cohort studies found mixed results which may be depend on different outcome measures. Some of them suggested anesthetic exposure was association with poor neurodevelopmental outcome, but not causality. Most well-conducted clinical trials including PANDA (General Anesthesia compared to Spinal Anesthesia) and GAS (Pediatric Anesthesia and Neurodevelopment Assessment) suggested encouraging results that there is no significant neurocognitive deficit for single or brief anesthetic exposure early in life. The effect of anesthesia neurotoxicity may be time-dependent which remained to be proved.Summary: A majority of well-designed studies provide some reassurance regarding single or brief anesthetic exposure on immature human brain, but many questions surrounding early anesthesia and cognition remain unanswered. So far, surgeons, anesthesiologists, and parents should be careful, as far as possible to reduce the number and duration of children exposed to anesthetics. Elective surgeries should be delayed to more than 3 years of age.  Citation:  Si-Meng Liu, An-Shi Wu, Yun Yue. Does general anesthesia have detrimental effects on immature human brain? J Anesth Perioper Med 2017; 4: 129-38. doi:10.24015/JAPM.2017.0024This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.