October 2013

SmartTots Featured at Anesthesiology 2013

Special thank you to ASA, SNACC, and SPA!

SmartTots would like to extend a special thank-you to the American Society of Anesthesiologists, the Society for Neuroscience in Anesthesiology and Critical Care, and the Society for Pediatric Anesthesia for providing SmartTots with complimentary booth space at the their annual meetings in San Francisco this month. We continue to receive much support from affiliated organizations and its members.


Research News & Updates

A systematic review and quantitative analysis of neurocognitive outcomes in children with four chronic illnesses.

Concern has been expressed that infants and children exposed to uneventful surgery and anesthesia may incur neurological injury that becomes manifest in poor scholastic performance or future learning difficulties. A recent meta-analysis of seven clinical studies examined the relationship between learning or behavior difficulties and pediatric exposure to anesthesia/surgery and reported an odds ratio of 1.4; however, the level of association and causal factors remain unclear. The purpose of our study is to provide context to the pediatric anesthesia neurotoxicity question by reviewing the evidence linking four childhood illnesses with neurocognitive development. In the present review, we have sought to quantify the magnitude of the impact of chronic illness on neurocognitive development through a systematic review of publications that report the developmental trajectory of patients with four childhood diseases: cystic fibrosis (CF), hemophilia A, end-stage renal disease (ESRD) and end-stage liver disease (ESLD). Read more


Neurotoxicity of general anesthetics in childhood: does anesthesia leave its mark on premature babies, newborns and infants?

Many animal experiments have shown that anesthetics can have a neurotoxic effect on immature brains because they induce apoptosis and influence neurogenesis and synaptogenesis. In animal experiments this has substantial implications for the neurocognitive functions of animals in later life. Whether these results of animal experiments can be transferred to humans is currently the subject of intensive research. In several retrospective studies no clear association between anesthesia in premature babies, newborns or infants and the occurrence of learning disorders or behavioral problems could be found.  Read more


Long-term effects of neonatal single or multiple isoflurane exposures on spatial memory in rats.

General anesthetics are neurotoxic to neonatal rodents and non-human primates. Neonatal exposure to general anesthetics has been associated with long-term cognitive deficits in animal models. Some data from humans are consistent with long-term deleterious effects of anesthetic exposure early in life on cognitive development, with multiple exposures to general anesthetics being particularly damaging. We sought to determine whether repeated exposure of neonatal rats to anesthesia was associated with long-term cognitive impairments and whether the magnitude of impairments was greater than that resulting from a single exposure. Read more


Repeated exposure to propofol potentiates neuroapoptosis and long-term behavioral deficits in neonatal rats.

Previous studies have shown that exposure of the immature brain to drugs that block NMDA glutamate receptors or drugs that potentiate GABA(A) receptors can trigger widespread neuroapoptosis. Almost all currently used general anesthetics have either NMDA receptor blocking or GABA(A) receptor enhancing properties. Propofol, a new intravenous anesthetic, is widely used in pediatric anesthesia and intensive care practice whose neurotoxicity on brain development remains unknown. We investigated the effects of neonatal propofol anesthesia on neuroapoptosis and long-term spatial learning/memory functions. Propofol was administered to 7 day-old rats either as a single dose or in 7 doses at concentrations sufficient to maintain a surgical plane of anesthesia. Immunohistochemical studies revealed a significant increase in the levels of caspase-3 in the hippocampal CA1 region after propofol administration. At postnatal day 34, light microscopic observations revealed a significant reduction in neuronal density and apparent morphological changes in the pyramidal cells of rats that had received 7 doses of propofol. These rats showed a longer escape latency/path length, less time spent in the target quadrant and fewer original platform crossings in the Morris Water Maze test. Read more