For decades, the question of neonatal anesthetic toxicity has variably met with passionate concern, perplexity, or indifference among the anesthesia practitioner and investigator communities. What began as a laboratory observation and academic curiosity of unknown clinical relevance, leading to clinical research and clinical concern, was elevated to a real clinical predicament by an unexpected 2016 U.S. Food and Drug Administration (FDA) Safety Announcement declaring that “repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children’s brains,” with admonitions to healthcare professionals, parents, pregnant women, and caregivers. This was followed in 2017 by FDA–approved formalized changes to several drug labels to memorialize this warning. The aftermath has seen heightened consternation and confusion, with variable response among parents, practitioners, regulators, anesthesiology societies, healthcare institutions, and their risk managers, as well as changes (or not) in informed consent, and several position statements and commentaries. Having allowed this initial flurry to subside, Anesthesiology this month features two comprehensive review articles and accompanying editorials on anesthetic developmental neurotoxicity in animals and in humans.
- Effects of repeated exposure to different concentrations of sevoflurane on the neonatal mouse hippocampus
- Early life exposure to extended general anesthesia with isoflurane and nitrous oxide reduces responsivity on a cognitive test battery in the nonhuman primate
- Anesthesia affects excitatory/inhibitory synapses during the critical synaptogenic period in the hippocampus of young mice: Importance of sex as a biological variable
- Electron microscopy techniques employed to explore mitochondrial defects in the developing rat brain following ketamine treatment
- Lipidomics reveals a systemic energy deficient state that precedes neurotoxicity in neonatal monkeys after sevoflurane exposure