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.
- Cognitive Impairment and Endoplasmic Reticulum Stress Induced by Repeated Short-Term Sevoflurane Exposure in Early Life of Rats
- Comparison of neurotoxicity of dexmedetomidine as an adjuvant in brachial plexus block in rats of different age
- Effect of multiple neonatal sevoflurane exposures on hippocampal apolipoprotein E levels and learning and memory abilities
- Lipid profiling as an effective approach for identifying biomarkers/adverse events associated with pediatric anesthesia
- Influence of nitrous oxide on granule cell migration in the dentate gyrus of the neonatal rat