Neurodevelopmental Effects of General Anaesthesia on the Developing Brain: A Structured Review of the Current Literature

Concerns have emerged regarding the potential neurodevelopmental effects of general anaesthesia (GA) administered during early childhood. Recent research has investigated the long-term cognitive complications that may arise in children following the administration of GA. Preclinical studies suggest that anaesthetic agents may induce neuroapoptosis and disrupt neurogenesis in developing brains. This review evaluated current literature to determine whether GA exposure in children is associated with long-term cognitive or behavioural impairments. A structured literature review was conducted using the PubMed database. The inclusion criteria focused on original research assessing neurodevelopmental outcomes for children following GA exposure. Retrospective cohort studies and prospective trials were analysed, while meta-analyses and systematic reviews were excluded. The retrospective cohort studies suggest that multiple or prolonged exposure to GA in childhood may be associated with increased risk of learning difficulties, behavioural disorders, and reduced academic performance. By contrast, the prospective studies, such as the general anaesthesia or awake-regional anaesthesia in infancy (GAS) trial, Paediatric Anaesthesia and Neurodevelopment Assessment (PANDA), and Mayo Anaesthesia Safety in Kids (MASK) trials, found no significant neurodevelopmental deficits following a single short-duration exposure. The MASK study did, however, note that potential behavioural risks were associated with repeated exposure. Variability in the design of the studies, the outcome measures, and confounding factors limited direct comparison across the studies. The current evidence does not support a definitive link between single GA exposure and long-term neurodevelopmental harm in children but does suggest that repeated or prolonged exposure may increase the risk of harm. Further high-quality research is required to clarify these associations.