Anaesthesia and the developing nervous system: advice for clinicians and families

Abstract

Download the podcast here Access the CPD MCQs for this issue online here ### Key points Many very small preterm babies and those with complex congenital anomalies and multisystem disorders are now surviving and need to undergo surgery.1 The very small, complex, or sick infant often needs multiple procedures and outcomes are now being scrutinized very closely. Anaesthetic agents do have the potential to harm the developing infant brain and the animal research that alerted us to this issue has been alarming. A number of epidemiological studies in humans have also raised cause for concern, but these have limitations and so prospective approaches have been developed and are in process now. Clinicians and families are worried by the information reaching the media and a balanced, cautious approach is needed to ensure risks and benefits of anaesthesia in early life are explained. The benefits and risks of regional anaesthesia and use of adjuncts to prolong blocks are now clearer after recent research and awake regional anaesthesia is feasible in certain cases. In this article, I will summarize the concerns and the key recent literature and will provide balanced advice to clinicians to assist them in practice and in their discussions with families. A wide range of anaesthetic agents has been implicated in causing neuronal apoptosis (programmed cell death) and …