Paediatric anaesthesia: a rapidly evolving subspecialty (original) (raw)

Current opinion in anaesthesiology, 2018

Abstract

DOI:10.1097/ACO.0000000000000596 The interests in research and outcome in children exposed to anaesthesia and surgery has increased dramatically the past 10–15 years as a consequence of the increasing volume of preclinical studies demonstrating that general anaesthetics are neurotoxic to the immature animal brain. This paediatric issue of Current Opinion in Anaesthesiology contains nine interesting review articles by some of the leading scientific paediatric anaesthesiologist underlining this fact. The first article is by Walid Habre from Geneva, Switzerland. He is the lead investigator of the APRICOT study which was published in the Lancet Respiratory Medicine in May 2017 [1]. In his review article (pp. 292–296), he interprets the results of the APRICOT study and highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anaesthesia management of children in Europe. In the second article (pp. 297–301), Tom G. Hansen from Odense, Denmark and Thomas Engelhardt from Aberdeen, Scotland provide an update on the human studies regarding neurocognitive outcomes following anaesthesia and surgical exposures in early life. They argue that it may well be biologically plausible that anaesthetic agents induce structural changes during mammalian brain development and beyond. However, in the absence of alternatives, the impact of the choice of anaesthetic drugs on long-term neurocognitive outcomes is almost certainly to be of limited relevance in humans. The underlying disease processes, surgical intervention and trauma as well as other known perioperative factors affect these outcomes more significantly. As a spin-off from the GAS study [2] – the only randomized controlled trial on this topic so far – a number of additional studies have been published, for example regarding to the safety and efficacy of regional anaesthesia in infants. Some of these studies are summarized (pp. 302–307) by Nicola Disma and Natasha Lunies-Ross from London, United Kingdom and George A. Chalkiakis from Melbourne, Australia. They conclude that spinal

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