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Long-Term Consequences of Anesthesia (and Surgery) on the Infant Brain

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Perioperative Medicine in Pediatric Anesthesia

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Abstract

Very few issues (if any) within pediatric anesthesia have caused so much concern and emotional gravity than the fact that the past roughly 15 years, a plethora of animal studies have uniformly shown that exposure to most of the currently used anesthetics possibly during a vulnerable period of brain development (i.e. brain growth spurt or peak of synaptogenesis) may lead to neurodegeneration (particularly apoptosis) and abnormal synaptic development. Importantly, the observed morphological abnormalities are associated with functional deficits in learning and behavior later in life. Initial studies were mainly performed in immature rodent pups, but more recent studies have included non-human primates (rhesus monkeys). Both gamma-aminobutyric acid (GABA) agonists (e.g. inhalational anesthetics, propofol and benzodiazepines) and n-methyl-d-aspartate (NMDA) antagonists (e.g. ketamine and nitrous oxide) are implicated. Given the number of neonates, infants and young children anesthetized annually worldwide, these findings could have significant public health impplications. So far relatively few human (cohort) studies have been published on this topic and the results have been inconclusive. Some studies have suggested an association between exposure to anesthesia (and surgery), but other studies have suggested the opposite. Ongoing prospective studies will provide new results withis few years' time.This chapter describes some of the preclinical background behind anesthesia-related neurotoxicity; however main focus is placed on human studies. Although disturbing the animal data lack verification in humans. At this point, there is no need to change current anesthetic clinical practice or to postpone or cancel truly urgent surgeries in young children.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care – Pediatric Section, Odense University Hospital, Odense, DK-5000, Denmark

    Tom Giedsing Hansen MD, PhD

  2. Institute of Clinical Research – Anesthesiology, University of Southern Denmark, Odense, DK-5000, Denmark

    Tom Giedsing Hansen MD, PhD

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  1. Tom Giedsing Hansen MD, PhD
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Correspondence to Tom Giedsing Hansen MD, PhD .

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Editors and Affiliations

  1. UCO di Anestesia e Rianimazione, AO-U Policlinico di Catania, Catania, Italy

    Marinella Astuto

  2. MUHC Montreal Children’s Hosp, McGill Un, Department of Anesthesia, Montreal, Canada

    Pablo M Ingelmo

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Hansen, T.G. (2016). Long-Term Consequences of Anesthesia (and Surgery) on the Infant Brain. In: Astuto, M., Ingelmo, P. (eds) Perioperative Medicine in Pediatric Anesthesia. Anesthesia, Intensive Care and Pain in Neonates and Children. Springer, Cham. https://doi.org/10.1007/978-3-319-21960-8_24

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  • DOI: https://doi.org/10.1007/978-3-319-21960-8_24

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21959-2

  • Online ISBN: 978-3-319-21960-8

  • eBook Packages: MedicineMedicine (R0)

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