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Should we be anesthetizing young children

In 2007, the FDA advisory committee on anesthesia recommended that «children less than 3 years of age not undergo elective procedures» because of concerns regarding anesthetic toxicity(1). The vast majority of the evidence upon which that recommendation was based on young rodents and primates. These studies implicated virtually every available anesthetic as a cause of apoptosis in the young. However, the positive predictive value of evidence from animals for apoptosis in humans is exceedingly small, 10-20%. In addition, socializing and exercise appear to mitigate the damage in young brains, possibly explaining why the gross anatomical changes in the brains of young animals are inconsistent with the experience in humans. Perhaps more importantly, interventions including preconditioning and caspase-3 inhibitors have substantially reduced the injury in these young animals. In this lecture, we review the available evidence that demonstrates that anesthetics (and other compounds) cause neuroapoptosis and neurocognitive dysfunction in young animals, address the limited external validity of these data and present strategies that prevent or limit anesthetic-associated injury in vulnerable animals.