Does general anesthesia affect neurodevelopment in infants and children?

Dear Editor,

Greetings for the new year. We have read the article entitled “Does general anesthesia affect neurodevelopment in infants and children” by McCann M, and Soriano G (BMJ 2019;367:l6459). As a medical student working with a consultant paediatric anaesthetist, we were delighted to see an article published exploring the possibility of anaesthetic induced neurotoxicity in children. Considering the indisputable link between the use of general anaesthesia and abnormal neurodevelopment in laboratory models, we think it is essential to continue research into this field. We want to congratulate the authors for this successful review article and respond with our thoughts.

The article uses a comprehensive PubMed search to collect studies for evaluation, and the authors communicate their search terms, prioritised study types, and exclusion criteria. However, the sole use of PubMed indexed literature is a limiting factor. Other databases of medical literature, such as MEDLINE, Cochrane, and EMBASE, were not used. Similarly, only English language studies were included, which is likely to reduce the number of relevant studies to be identified. Furthermore, there is no mention of the use of unpublished studies; whether they were included or excluded as part of the author’s literature search. Nonetheless, we would commend the authors on the thorough and precise review of each piece of literature included in the article. The evidence presented by the authors was extensive and clearly written; although, due to the large volume of data, a forest plot or table compiling the various studies’ outcomes would have been a welcome addition.

The article concludes that despite some evidence to suggest general anaesthesia may have the potential to induce neurotoxicity in children, there is very little clinical evidence exists to suggest that significant harm is being caused. We would agree with this opinion with the addendum that further research into the issue needs to be undertaken.

Sincerely,

Mr Jack Broadbent, final year medical student, Barts and the London School of Medicine

Dr Vinod Patil, Consultant Anaesthetist, Barking, Havering and Redbridge University Hospitals NHS Trust.