Anesthesia Exposure in the Young Child and Long-term Cognition: An Integrated Review

Abstract

Millions of children every year undergo seemingly safe general anesthetics for surgical procedures and imaging studies. Anesthetic agents have been shown to cause detrimental effects on brain cell survival and cognitive function in animals. As a result, the safety of general anesthetics in children is an active field of investigation. The objective of this review is to evaluate the human research on anesthesia neurotoxicity in the young child. Three databases were searched for studies on anesthesia exposure in infants and children. Positive clinical outcomes in several studies showed no difference in cognitive function between children exposed and unexposed to anesthesia. Research findings also demonstrated negative clinical outcomes following anesthesia exposure, including physical changes on magenetic resonance imaging such as lower gray matter density in the occipital cortex and cerebellum; lower scores on performance IQ, listening comprehension, and expressive language; overrepresentation in the lowest fifth percentile of academic achievement; and increased risk of learning disabilities. More studies are needed that simultaneously measure cognitive function, physical changes, and disability risk to learn how these factors interact in the human brain.

Keywords: General anesthesia; neurotoxicity; pediatrics.