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.
- Cell cycle activation contributes to isoflurane-induced neurotoxicity in the developing brain and the protective effect of CR8.
- Protective Effects of Xenon on Propofol-Induced Neurotoxicity in Human Neural Stem Cell-Derived Models.
- Neonatal exposure to propofol affects interneuron development in the piriform cortex and causes neurobehavioral deficits in adult mice.
- The expression of glucose transporters and mitochondrial division and fusion proteins in rats exposed to hypoxic preconditioning to attenuate propofol neurotoxicity.
- Inhibition of microRNA-375 ameliorated ketamine-induced neurotoxicity in human embryonic stem cell derived neurons.