In this correspondence, the authors comment on the report by Shi and colleagues1 on the association between attention-deficit/hyperactivity disorder (ADHD) and exposure to anaesthesia in early childhood. The debate concerning the clinically relevant neurotoxic effects of general anaesthesia has yet to be resolved. The data from animal models are impacted by differences in neurogenesis 2 and the duration of exposure and uncertainty around whether vulnerability is determined by organism or neuronal age. 3 The authors find that we are therefore highly reliant upon the ‘natural experiment’ of clinically indicated anaesthesia exposure to identify the effect on children. As anaesthesia exposure is not randomly distributed across the population, there is significant risk of confounding by indication, as the authors acknowledge. 1
Andrew Conway Morris & Anke Conway Morris.
British Journal of Anaesthesia March 2022
Editorial in response to this original research paper.