JAMA Pediatrics, June 2014.
Williams R; Pfister R, Black I.


Each year, millions of children worldwide undergo anesthesia to facilitate surgical, diagnostic, and therapeutic procedures. According to all currently available clinical measurements, modern neonatal anesthesia appears to be extremely safe. However, during the past decade disturbing evidence has begun to accumulate concerning the neurotoxicity of commonly used anesthetic agents and sedatives. A fundamental assumption of anesthetic practice has always been that the effects of sedatives and anesthetic agents resolve when these drugs are metabolized and excreted from the body. This core assumption has recently been challenged by compelling evidence in animals that administration of these drugs may permanently change the architecture and function of the central nervous system. In this context, we welcome the publication by Morriss et al in this issue of the journal. However, as is true with every human neurotoxicity study to date, their work raises as many questions as it answers. Pediatricians and neonatologists have a vital role to play as we attempt to unravel the mysteries of an extraordinarily murky field of research where, as Alice found, things continue to grow curiouser and curiouser.

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