Update on neonatal anesthetic neurotoxicity: insight into molecular mechanisms and relevance to humans.

A fundamental premise of general anesthesia is that anesthetics produce a reversible state of unconsciousness and unresponsiveness. Implicit in this premise is that the brain and spinal cord are neurophysiologically the same before and after anesthesia. Recent experimental data has questioned the complete reversibility of anesthesia. In certain circumstances, anesthetic exposure in neonatal animals leads to neuronal death. Given the large number of neonates and infants that undergo surgery and anesthesia, the implications of these data for anesthesia in humans are readily apparent. Although the relevance of these findings to humans is a subject of heated debate, the unequivocal demonstration of neuronal death in animals exposed to clinically relevant concentrations of anesthetics has provoked significant concern amongst anesthesia care providers and patients. This editorial reviews new laboratory and clinical research presented at the Anesthesiology/Foundation for Anesthesia Education and Research Session at the Annual Meeting of the American Society of Anesthesiologists, Oct 21, 2008 which advances our understanding in this area.