Pediatric anesthesia and neurotoxicity: can findings be translated from animals to humans?

Abstract

Many studies have demonstrated a neurodegenerative effect of anesthetic drugs in cubs and young animals, raising the concern that similar effects can happen in children, and that the administration of anesthesia in young children undergoing surgical or diagnostic procedures may cause long-term neurocognitive impairment. Thus, several epidemiological studies have been performed with the aim to find a possible association between early anesthesia exposure and poor long-term outcome, like learning disabilities or worse school grading and two prospective trials are currently running, the GAS and the PANDA study. Interim results from the GAS study, which compared infants undergoing general and regional anesthesia for hernia repair, have demonstrated that a single exposure of about one hour of anesthesia does not affect the neurological outcome at 2 years of age. Nowadays, most of the knowledge in the field of anesthesia and its potential long-term effects comes from studies performed in animals, but findings are difficult to extrapolate and they do not predict results from similar studies performed in humans. Nonetheless, studies in animals are necessary to better understand the effects of anesthetics and the mechanistic of potential anesthesia-related neurotoxicity. Studies in humans must run in parallel in order to determine whether similar effects may occur in young patients.