FOR more than a decade, the possibility that exposure to anesthetics may be harmful to the developing human brain has intrigued anesthesiologists and the public alike. The urgent desire to create more clarity and the need to inform parents of young children who need surgery have spawned intense research activity, including well-designed experimental studies in relevant neonatal species, as well as human epidemiologic studies in retrospective and prospective observational pediatric cohorts. In addition to these efforts, the public/private International Anesthesia Research Society/US Food and Drug Administration initiative SMARTTots(www.smarttots.org) and the European Society of Anaesthesiology–sponsored (Brussels, Belgium) “ EuroStar” consortium (www.esahq.org/research/research-groups/eurostar) each coordinate research initiatives, help secure research funding, and disseminate important new results to the academic community, healthcare providers, and public arenas. Initial statements regarding the clinical consequences of anesthetic neurotoxicity concluded that there was still insufficient evidence to advise postponing surgery to a later age (http://smarttots.org/about/consensus-statement/). However, possibly fueled by emerging evidence from ongoing primate studies, the recent (2015) SmartTots advisory has a slightly more cautious tone, suggesting that the optimal timing of surgery needs to be discussed among all stakeholders

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