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Chapter 3 - Anesthetic Neurotoxicity in Children

Published online by Cambridge University Press:  30 November 2019

By
Adam C. Adler  and
Dean B. Andropoulos
Edited by
Adam C. Adler ,
Arvind Chandrakantan  and
Ronald S. Litman
Adam C. Adler
Affiliation:
Texas Children's Hospital
Arvind Chandrakantan
Affiliation:
Texas Children's Hospital
Ronald S. Litman
Affiliation:
The Children's Hospital of Philadelphia
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Summary

This chapter, provides an overview on the concerns centered on neurotoxicity from anesthetics in children following the FDA warning from 2016 and 2017. The authors provide a background for both clinical and basic science evidence on the effects of commonly used anesthetics on neural development.After review of the landmark studies in both animals and humans, the chapter provides suggestions for reducing exposure as well as addressing parental concerns.

Keywords

NeurotoxicitypediatricsapoptosisPANDA studyGAS studyinhalation anesthesiaFDAFDA warning.
Type
Chapter
Information
Case Studies in Pediatric Anesthesia , pp. 16 - 18
Publisher: Cambridge University Press
Print publication year: 2019

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References

Suggested Reading

Andropoulos, DB, Greene, MF. Anesthesia and developing brains: implications of the FDA warning. N Engl J Med. 2017;376(10):905–7. PMID: 28177852.CrossRefGoogle ScholarPubMed
Brambrink, AM, Evers, AS, Avidan, MS, et al. Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain. Anesthesiology. 2010;112(4):834–41. PMID: 20234312.CrossRefGoogle ScholarPubMed
Brambrink, AM, Evers, AS, Avidan, MS, et al. Ketamine-induced neuroapoptosis in the fetal and neonatal rhesus macaque brain. Anesthesiology. 2012;116(2):372–84. PMID: 22222480.CrossRefGoogle ScholarPubMed
Creeley, C, Dikranian, K, Dissen, G, et al. Propofol-induced apoptosis of neurones and oligodendrocytes in fetal and neonatal rhesus macaque brain. Br J Anaesth. 2013;110 Suppl 1:i29–38. PMID: 23722059.CrossRefGoogle ScholarPubMed
Davidson, AJ, Disma, N, de Graaff, JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet. 2016;387:239–50. PMID: 26507180.CrossRefGoogle ScholarPubMed
FDA Drug Safety Communication: FDA approves label changes for use of general anesthetic and sedation drugs in young children. www.fda.gov/Drugs/DrugSafety/ucm554634.htm.Google Scholar
Flick, RP, Katusic, SK, Colligan, RC, et al. Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics. 2011;128(5):e1053–61. PMID: 21969289.Google Scholar
Ikonomidou, C, Bosch, F, Miksa, M, et al. Blockade of NMDA receptors and apoptotic neurodegeneration in the developing brain. Science. 1999;283(5398):70–4. PMID: 9872743.CrossRefGoogle ScholarPubMed
McCann, ME, de Graff, JC, Dorris, L, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. The Lancet. 2019;393(10172):P664–677.CrossRefGoogle ScholarPubMed
Sun, LS, Li, G, Miller, TL, et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA. 2016;315(21):2312–20. PMID: 27272582.CrossRefGoogle ScholarPubMed
Warner, DO, Zaccariello, MJ, Katusic, SK, et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the Mayo Anesthesia Safety in Kids (MASK) study. Anesthesiology. 2018;129(1):89–105. PMID: 29672337.CrossRefGoogle ScholarPubMed

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