Anesthesia and the developing brain

A way forward for laboratory and clinical research

Nicola Disma, James D. O'Leary, Andreas W. Loepke, Ansgar M. Brambrink, Karin Becke, Nicola G. Clausen, Jurgen C. De Graaff, Fang Liu, Tom G. Hansen, Mary E. McCann, Cynthia F. Salorio, Sulpicio Soriano, Lena S. Sun, Peter Szmuk, David Oman Warner, Laszlo Vutskits, Andrew J. Davidson

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

All commonly used general anesthetics have been shown to cause neurotoxicity in animal models, including nonhuman primates. Opinion, however, remains divided over how cumulative evidence from preclinical and human studies in this field should be interpreted and its translation to current practices in pediatric anesthesia and surgery. A group of international experts in laboratory and clinical sciences recently convened in Genoa, Italy, to evaluate the current state of both laboratory and clinical research and discuss future directions for basic, translational, and clinical studies in this field. This paper describes those discussions and conclusions. A central goal identified was the importance of continuing to pursue laboratory research efforts to better understand the biological pathways underlying anesthesia neurotoxicity. The distinction between basic and translational experimental designs in this field was highlighted, and it was acknowledged that it will be important for future animal research to try to causally link structural changes with long-term cognitive abnormalities. While inherent limitations will continue to affect the ability of even large observational cohorts to determine if anesthesia impacts neurodevelopment or behavioral outcomes, the importance of conducting further large well-designed cohort studies was also emphasized. Adequately powered cohorts could clarify which populations are at increased risk, provide information on environmental and healthcare-related risk modifiers, and guide future interventional trials. If anesthetics cause structural or functional adverse neurological effects in young children, alternative or mitigating strategies need to be considered. While protective or mitigating strategies have been repeatedly studied in animals, there are currently no human data to support alternative anesthetic strategies in clinical practice. Lastly, it was noted that there is still considerable debate over the clinical relevance of anesthesia neurotoxicity, and the need to evaluate the impact of other aspects of perioperative care on neurodevelopment must also be considered.

Original languageEnglish (US)
Pages (from-to)758-763
Number of pages6
JournalPaediatric Anaesthesia
Volume28
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Anesthesia
Brain
Research
Anesthetics
Medical Laboratory Science
Perioperative Care
General Anesthetics
Primates
Italy
Cohort Studies
Research Design
Animal Models
Pediatrics
Delivery of Health Care

Keywords

  • anesthesia
  • clinical trial
  • neurodevelopment
  • neurotoxicity
  • pediatrics
  • research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Anesthesiology and Pain Medicine

Cite this

Disma, N., O'Leary, J. D., Loepke, A. W., Brambrink, A. M., Becke, K., Clausen, N. G., ... Davidson, A. J. (2018). Anesthesia and the developing brain: A way forward for laboratory and clinical research. Paediatric Anaesthesia, 28(9), 758-763. https://doi.org/10.1111/pan.13455

Anesthesia and the developing brain : A way forward for laboratory and clinical research. / Disma, Nicola; O'Leary, James D.; Loepke, Andreas W.; Brambrink, Ansgar M.; Becke, Karin; Clausen, Nicola G.; De Graaff, Jurgen C.; Liu, Fang; Hansen, Tom G.; McCann, Mary E.; Salorio, Cynthia F.; Soriano, Sulpicio; Sun, Lena S.; Szmuk, Peter; Warner, David Oman; Vutskits, Laszlo; Davidson, Andrew J.

In: Paediatric Anaesthesia, Vol. 28, No. 9, 01.09.2018, p. 758-763.

Research output: Contribution to journalArticle

Disma, N, O'Leary, JD, Loepke, AW, Brambrink, AM, Becke, K, Clausen, NG, De Graaff, JC, Liu, F, Hansen, TG, McCann, ME, Salorio, CF, Soriano, S, Sun, LS, Szmuk, P, Warner, DO, Vutskits, L & Davidson, AJ 2018, 'Anesthesia and the developing brain: A way forward for laboratory and clinical research', Paediatric Anaesthesia, vol. 28, no. 9, pp. 758-763. https://doi.org/10.1111/pan.13455
Disma N, O'Leary JD, Loepke AW, Brambrink AM, Becke K, Clausen NG et al. Anesthesia and the developing brain: A way forward for laboratory and clinical research. Paediatric Anaesthesia. 2018 Sep 1;28(9):758-763. https://doi.org/10.1111/pan.13455
Disma, Nicola ; O'Leary, James D. ; Loepke, Andreas W. ; Brambrink, Ansgar M. ; Becke, Karin ; Clausen, Nicola G. ; De Graaff, Jurgen C. ; Liu, Fang ; Hansen, Tom G. ; McCann, Mary E. ; Salorio, Cynthia F. ; Soriano, Sulpicio ; Sun, Lena S. ; Szmuk, Peter ; Warner, David Oman ; Vutskits, Laszlo ; Davidson, Andrew J. / Anesthesia and the developing brain : A way forward for laboratory and clinical research. In: Paediatric Anaesthesia. 2018 ; Vol. 28, No. 9. pp. 758-763.
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