Pediatric Anesthetic During Brain Immaturity and Neurodevelopment Disorders

Abstract

Introduction: Several experimental and clinical studies suggest that drugs used in pediatric anesthesia may exert undesirable effects on the developing central nervous system. The objective of this review was to assess the results and conclusions of published studies on long lasting neurodevelopment disorders following exposure to anesthetics in children in a phase of brain immaturity.
Material and Methods: We performed a literature search in several sources (PubMed, SciELO and Cochrane Library) using the terms ‘Pediatric anesthesia OR Pediatric anesthetic OR Developing brain anesthetic OR Developing brain anesthesia AND behavior disorders’. We selected human studies, referring to long lasting neurodevelopment effects after exposure to anesthetics in the first four years of life.
Results: Ten retrospective studies met the inclusion criteria. Of these, seven suggest risk of neurobehavioral disorders after exposure of small children to anesthetics, as opposed to the results obtained by the other three.
Discussion: Although mostly using large databases, the studies found are retrospective, vary in test groups, include sometimes avoidable confounders and some present inaccuracies in the choice of the test and control populations that can compromise the reliability of the results.
Conclusion: Because of the numerous limitations of the few studies available, the reported results are still deemed insufficient to change current clinical practice. However, although it is undisputable that anesthesia should be provided when needed, regardless of age, the warnings found in literature are worrisome, therefore whenever surgery is unavoidable in small children, alternatives that may help reduce the risks of anesthetic exposure should be sought.
Keywords: Anesthesia; Anesthetics; Child; Infant; Brain/growth & development; Developmental Disabilities; Cognition Disorders;
Review Literature as Topic.