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A holistic view of anesthesia-related neurotoxicity in children

Authors Clausen N, Hansen T

Received 18 July 2015

Accepted for publication 16 October 2015

Published 26 November 2015 Volume 2015:2 Pages 131—141


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Gildasio S De Oliveira Jr.

Nicola G Clausen, Tom G Hansen

Department of Anesthesia and Intensive Care, Odense University Hospital, Odense, Denmark

Introduction: Animal studies (including in nonhuman primates) have shown that most general anesthetics cause enhanced neuroapoptosis in the immature brain with subsequent long-term neurocognitive deficits later in life. Whether human neurons are equally affected is yet unknown, but a final answer to this issue is still pending. To date, most human studies within the field are of observational nature and the results are conflicting. Some studies indicate an association between exposure to anesthesia and surgery while others do not.
Objective: This review summarizes results from preclinical and observational studies. Controversies and challenges regarding the interpretation of these results are presented. Crucial aspects of neurocognitive safety during pediatric anesthesia and surgery are highlighted. International initiatives aiming to improve the safe conductance of pediatric anesthesia are introduced.
Conclusion: So far, anesthesia-related neurotoxicity in humans remains an area of concern but it cannot be completely excluded. Clinical practice should not be changed until there are definite proofs that anesthetic exposure causes neurocognitive impairment later in life. Withholding necessary and timely surgeries as a consequence of any such concerns could result in worse harm. Focus of current research should also be redirected to include other factors, than merely anesthetics and surgery, that influence the neurocognitive safety of children perioperatively.

Keywords: pediatric anesthesia, neurotoxicity, anesthesia safety, neurocognitive development

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