In December 2012, SmartTots released a Consensus Statement on the Use of Anesthetics and Sedatives in Children to provide guidance to healthcare providers and parents with regard to research findings that suggest anesthetics may be harmful to the developing brain.  Since that time there has been a growing body of evidence from animal studies and observational studies in humans suggesting adverse effects on behavior, learning, and memory may result from exposure to anesthetics and sedation.

In June 2014 the International Anesthesia Research Society and SmartTots convened a group of experts in anesthesia, pediatric medicine, neuroscience, and patient safety to consider the emerging evidence and review the 2012 statement.  This draft Consensus Statement on the Use of Anesthetic and Sedative Drugs in Infants, Toddlers, and Preschool Children is the result of many hours of deliberation by that diverse group of experts. Feedback has been obtained from more than 20 stakeholder organizations, and the statement is currently undergoing final review.

The following statement is a draft revision that has not been approved by the FDA or endorsed by any organizations. The final version will be posted as soon as it is available.


(Draft 2014 Revision)

Each year, millions of infants, toddlers, and preschool children require anesthesia and/or sedation for surgery and procedures. Animal studies demonstrate long-term, possibly permanent adverse effects of anesthetic and sedative drugs on the developing brain. These include adverse effects on behavior, learning, and memory. Observational studies in children suggest that similar deficits may occur. These studies in children had limitations that prevent experts from drawing conclusions on whether the harmful effects were due to the anesthesia or to other factors, including surgery, hospitalization, or pre-existing conditions, and from determining the ages at which children are vulnerable. We need to know if anesthetic and sedative drugs cause brain damage in infants, toddlers, and preschool children. Therefore funding for further research, including definitive clinical trials, is required.

Infants, toddlers, and preschool children may be more vulnerable to the adverse effects of anesthetic and sedative drugs. This emerging information from animal and human studies is concerning to healthcare providers and parents. Nevertheless, many surgeries and procedures in this age group are necessary and may require the use of anesthetics and sedatives. Until further research clarifies the significance of these findings we recommend:

  • Parents and caregivers should discuss the risks, benefits, and timing of surgery and procedures requiring anesthetics and sedative drugs. Surgeries and procedures requiring anesthetic and sedative drugs that could reasonably be delayed should possibly be postponed because of the potential risk to the developing brain of infants, toddlers, and preschool children.
  • When surgeries and procedures are required using current standard of care anesthetics, consider participating in a study to help identify better anesthetic and sedative practices and/or drugs that have the least effect on the developing brain. Clinical trial information can be found at
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