Postoperative Cognitive Function Following General Anesthesia in Children

Abstract

Research into the developmental effects of anesthetic use began from the study of the fetal and postnatal effects of maternal alcohol consumption. Broadly speaking, alcohol is an anesthetic of sorts, and its toxicity as such has been firmly established: there is a consensus on the danger of alcohol to children as the warning label on every can of beer reminds us. Furthermore, studies using rodents have largely confirmed the toxicity of anesthetics on the developing brain. Although some human retrospective observational studies have found anesthetics to be toxic while others have not, as mentioned earlier the difficulty of assembling cohorts with matching backgrounds has rendered interpretation of the results difficult. To date, two large-scale human studies have been conducted; the preliminary findings of one of these demonstrated no apparent effect of the short-term use of anesthetics on healthy children. Against this, we have the warning issued by the FDA and based on the results of the animal studies and retrospective observation studies, which applies to all anesthetics and sedatives besides alpha-2 agonists, as previously described: the extended or multiple use of these agents in children younger than 3 years of age or in fetuses during the third trimester may adversely affect brain development. In light of the foregoing information, the clinician is left to ponder the very serious question of which anesthetic procedures to use with pediatric patients. Given the state of our current knowledge, the answer to this question must be to shorten exposure as much as possible and to limit the dosage to strictly appropriate quantities. The prevailing view at present is that short-term exposure of healthy children to anesthetics has no adverse effects on brain development.