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August 2014

The Neonatologist’s Role in Pediatric Anesthesia Neurotoxicity

Author Affiliations
  • 1Department of Anesthesia, Vermont Children’s Hospital, University of Vermont, Burlington
  • 2Department of Pediatrics, Vermont Children’s Hospital, University of Vermont, Burlington
JAMA Pediatr. 2014;168(8):701-703. doi:10.1001/jamapediatrics.2014.469

“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”
“How do you know I’m mad?” said Alice.
“You must be,” said the Cat, “or you wouldn’t have come here.”

Lewis Carroll, Alice’s Adventures in Wonderland

Each year, millions of children worldwide undergo anesthesia to facilitate surgical, diagnostic, and therapeutic procedures. According to all currently available clinical measurements, modern neonatal anesthesia appears to be extremely safe.1 However, during the past decade disturbing evidence has begun to accumulate concerning the neurotoxicity of commonly used anesthetic agents and sedatives. A fundamental assumption of anesthetic practice has always been that the effects of sedatives and anesthetic agents resolve when these drugs are metabolized and excreted from the body. This core assumption has recently been challenged by compelling evidence2-5 in animals that administration of these drugs may permanently change the architecture and function of the central nervous system. In this context, we welcome the publication by Morriss et al6 in this issue of the journal. However, as is true with every human neurotoxicity study to date, their work raises as many questions as it answers. Pediatricians and neonatologists have a vital role to play as we attempt to unravel the mysteries of an extraordinarily murky field of research where, as Alice found, things continue to grow curiouser and curiouser.

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