SmartTots : Making Anesthesia Safer for Children

SmartTots brings world-renowned physicians and researchers together to study and improve anesthesia use for children.

About SmartTots

SmartTots is a collaborative effort sponsored by the IARS and designed to increase the safety of anesthetic and sedative drugs for the millions of children who undergo medical procedures each year.

In 2009, to address the growing concern about the potential adverse consequences of general anesthesia in young patients, the U.S. Food and Drug Administration (FDA) and the International Anesthesia Research Society (IARS) established a public-private partnership (PPP). Under the SmartTots PPP, the IARS brought together multiple stakeholders, including academic research institutions, medical professionals and societies, and other government and nonprofit organizations to address scientific and clinical gaps regarding the safe use of anesthetics and sedatives in children. While non-human studies confirm a link between anesthesia use and damage to the developing brain in animals, currently there is insufficient clinical evidence to establish a clear link between the effects of these drugs on the development of the human brain. The FDA partnership has concluded, but IARS continues the essential work of SmartTots to address the gaps in research and make anesthesia and sedation safer for children around the world.

Research funded through SmartTots investigates multiple aspects of existing anesthetics and their administration, including dosage and exposure. Findings from these studies will establish new practice guidelines and, as necessary, new age-appropriate anesthetics.

About the IARS

IARS is a nonpolitical, not-for-profit medical society dedicated to advancing and supporting scientific research and education related to anesthesia, and to improving patient care through research. Founded in 1922, the IARS contributes more than $1 million annually to fund anesthesia research and provides a forum for leaders in anesthesia research to share information and ideas. Membership includes physicians and others engaged in anesthesia-related practice, research, and training worldwide.

SmartTots: 13 Years of Progress

During the 2000’s, preclinical research studies began to find that laboratory animals exposed to commonly used anesthetic and sedative drugs early in life showed changes to the brain and nervous system that interfered with memory and learning.  Additional research during this time set off alarms for the Food and Drug Administration (FDA), parents, and the anesthesia practitioner community. The FDA held its first Advisory Committee hearing on this issue in 2007. As an outcome of that meeting, representatives from the FDA reached out to the International Anesthesia Research Society (IARS) in 2008 with the idea of forming a Public Private Partnership to address these new, startling findings.  IARS was uniquely positioned to partner with the FDA due to its non-political collaborative mission, infrastructure, expertise and commitment to research, education and advancing the specialty.

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“SmartTots has been extremely valuable in bringing the scientific community together; the best possible science can be done through this coordinated effort.”

“SmartTots convenes and creates community.”


The SmartTots Scientific Advisory Board (SAB) is an interdisciplinary group of scientific and medical professionals responsible for providing advice and insight on the scientific priorities and research direction of SmartTots.  The SAB is comprised of individuals with appropriate scientific expertise representing a broad range of disciplines. As such, it includes experts in anesthesiology, developmental biology, developmental pediatrics, epidemiology, long-term pediatric outcomes trials, mechanisms of anesthetic action, neonatology, neuroimaging, neurology, neuroscience, pediatric anesthesiology, pediatric ethics, pharmacology, psychiatry, and other scientific disciplines necessary to perform the work of the board.


Dean Andropoulos, MD Texas Children’s Hospital and Baylor College of Medicine

Sue Beers, PhD Western Psychiatric Institute and Clinic

David C. Bellinger, PhD, MSc Harvard Medical School

Katherine Biagas, MD Stony Brook University Medical Center

Thomas G. Diacovo, MD University of Pittsburgh Medical Center

Robert H. Dworkin, PhD University of Rochester School of Medicine and Dentistry

Jack M. Fletcher, PhD University of Houston

Carol Ewing Garber, PhD Teachers College, Columbia University

Tomás Guilarte, PhD Florida International University

Terrie E. Inder, MD Harvard Medical School

Vesna Jevtovic-Todorovic, MD, PhD, MBA University of Colorado School of Medicine

Mervyn Maze, MB, ChB University of California, San Francisco

Phil Morgan, MD University of Washington

James O’Leary, MBBCh, MM, MD University College Cork, Ireland

Ashok Panigrahy MD University of Pittsburgh Medical Center

Bruce M. Psaty, MD, PhD University of Washington

Leonard Rappaport, MD, MS Boston Children’s Hospital

Virginia Rauh, ScD Mailman School of Public Health, Columbia University

Jeffrey Sall, MD, PhD University of California, San Francisco

Cynthia Salorio, PhD Johns Hopkins School of Medicine

Wendy R. Sanhai, PhD, MBA Duke University School of Medicine

Lena S. Sun, MD Columbia University Irving Medical Center

Alastair J.J. Wood MB, ChB Weill Cornell Medical College


The SmartTots Steering Committee provides overall coordination, management, direction, and oversight of the initiative. It is comprised of representatives from the IARS Board of Directors. The Steering Committee oversees appointments to the Executive Board, Scientific Advisory Board, and Affiliate Advisory Council.

Santhanam Suresh, MD, MBA, Chair | Beverley Orser, MD, PhD | Christian Werner, MD

Dean Andropoulos, MD, M.H.C.M

Tom Cooper, Executive Director | Tricia Brazil, Program Director