The US Food and Drug Administration issued a warning in December 2016 that prolonged or repeated exposure to general anesthesia and sedatives that block N-methyl-D-aspartate (NMDA) receptors or potentiate gamma-aminobutyric acid (GABA) activity could have a potentially negative impact on brain development in children. Children who undergo multiple procedures and those younger than 3 years who are exposed to general anesthesia for >3 hours were deemed at risk for potential neurotoxicity from anesthesia exposure. Unfortunately, the number of pediatric diagnostic and therapeutic procedures in children outside the operating room continues to increase, and non-anesthesiologists from various pediatric subspecialties play an increasingly important role in providing this care.  We have published previously that the risk for anesthesia/sedation neurotoxicity exists with sedation services outside the operating room and should be a concern for all pediatricians and pediatric subspecialists. , In this paper we report on the progress in anesthesia/sedation neurotoxicity since our original report. 

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Kamat, Simon, Sulton, Kudchadkar, & Raper
Academic Pediatrics October 2021