Neurodevelopment after general anaesthesia in infants

Concerns about anaesthesia-related neurological injury in young children have been increasing among parents, health-care providers, and regulatory organisations. These concerns were first prompted by animal studies that showed accelerated apoptosis and neuronal death after exposure to general anaesthetic drugs. 1 Jevtovic-Todorovic V Hartman RE Izumi Y et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003; 23: 876-882 Crossref PubMed Google Scholar Most commonly used general anaesthetic drugs have since been found to cause pervasive adverse neurological effects in vitro and in immature animals, including non-human primates. 2 Jevtovic-Todorovic V Exposure of developing brain to general anesthesia: what is the animal evidence?. Anesthesiology. 2018; 128: 832-839 Crossref PubMed Scopus (68) Google Scholar This issue gained widespread prominence in 2017, when the US Food and Drug Administration issued a safety communication stating that the use of general anaesthetic drugs “for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years”. 3 US Food and Drug AdministrationDrug safety communication: FDA approves label changes for use of general anesthetic and sedation drugs in young children. https://www.fda.gov/Drugs/DrugSafety/ucm554634.htmDate: April 27, 2017 Date accessed: November 5, 2018 Google Scholar Subsequently, warnings were added to the labels for these medicines. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trialSlightly less than 1 h of general anaesthesia in early infancy does not alter neurodevelopmental outcome at age 5 years compared with awake-regional anaesthesia in a predominantly male study population. Full-Text PDF Open Access