Anesthetic Exposure and Neurodevelopmental Outcomes in the Neonate

Abstract

With ongoing advances in cardiorespiratory monitoring and improved anesthetic techniques, preterm and full-term infants routinely undergo successful surgical procedures under general anesthesia to repair congenital defects that were considered lethal in the past. Recent studies in immature animals exposed to anesthetics and sedative agents, however, have demonstrated clear evidence of neurotoxicity and deficits in learning that do not occur in older animals with the same exposure. Initial epidemiologic studies in humans also raised concern when it was found that children exposed to multiple anesthetics before age 4 years were more likely to demonstrate subsequent behavioral and learning deficits. Moreover, several recent case reports have highlighted concerns about the potential negative effects of intraoperative hypotension and hypocapnia on neonates undergoing anesthesia. Since 2009, the US Food and Drug Administration has been working collaboratively with the International Anesthesia Research Society in a public-private partnership called SmartTots to design and fund research to investigate these concerns. This review outlines the most recent evidence from both animal and human studies about the effects of anesthetic and sedative drugs and anesthetic-related hemodynamic changes on the developing newborn brain.