Twenty-five years ago, surgery was commonly performed on awake or paralyzed infants and children without the benefit of analgesics, sedatives, or anesthetics. This practice was justified by a fear that these drugs would increase the risk of adverse surgical outcomes and the belief that infants did not experience pain. Subsequent clinical studies have demonstrated that inadequate sedation, anesthesia, and analgesia may actually increase the risk of adverse postoperative outcomes in infants and children and have led to a paradigm shift such that the use of general anesthetics and analgesics is now routine in the humane practice of pediatric anesthesiology. This does not mean that doing so is without risk or controversy. Seven years after this change, questions began to arise from the laboratory of John Olney, M.D., who was well known for his work on fetal alcohol syndrome, suggesting that exposure to anesthetics and sedatives with mechanisms of action similar to those of alcohol may result in adverse outcomes in neonatal animals. These findings have been replicated in multiple laboratories, using a number of animal species, and demonstrate that prolonged or repeated administration of anesthetics and sedatives to prenatal and neonatal animals is associated with abnormal brain development and an increased risk of cognitive and behavioral abnormalities in later life. In this issue of Anesthesiology, Dr. Jevtovic-Todorovic, a prominent investigator in the field, reviews the basic science literature that served to suggest to the U.S. Food and Drug Administration (FDA; Silver Spring, Maryland) a need for a warning on the use sedatives and anesthetics during pregnancy and early childhood.
- Prenatal Exposure to General Anesthesia and Childhood Behavioral Deficit
- Increasing the interval between repeated anesthetic exposures reduces long‐lasting synaptic changes in late post‐natal mice
- Tau Contributes to Sevoflurane-induced Neurocognitive Impairment in Neonatal Mice
- Neonatal exposure to sevoflurane expands the window of vulnerability to adverse effects of subsequent exposure to sevoflurane and alters hippocampal morphology via decitabine-sensitive mechanisms
- Sevoflurane Post-Conditioning Ameliorates Neuronal Deficits and Axon Demyelination After Neonatal Hypoxic Ischemic Brain Injury: Role of Microglia/Macrophage