Potential neurotoxicity of anesthetic drugs in young children: who cares? A survey among European anesthetists.

BACKGROUND: Potential neurotoxicity of anesthetic drugs is currently one of the most intensely discussed issues in pediatric anesthesia. Prospective human data are sorely lacking and there is an on-going debate among experts in the field whether one should (or can) extrapolate animal data to humans. Data regarding the thoughts of practicing anesthetists regarding this topic have not been published.

METHODS: A web-based survey to assess the thoughts of practicing (European) anesthetists regarding neurotoxicity and how it may have influenced their daily practice of pediatric anesthesia.

RESULTS: The majority (68.7%) of respondents regard neurotoxicity as an important topic, which they need to further explore. Two thirds have already changed their clinical practice and 44.3% were concerned about potential neurotoxicity. Anesthetists from children's hospitals were less likely to routinely inform parents about neurotoxicity (P=0.005) and more often applied an opioid-only anesthesia technique in selected premature neonates than general hospital based anesthetists (P<0.0001). Prospective human longitudinal studies focusing on neurodevelopment were given the highest priority for future research, whereas animal studies scored lowest.

CONCLUSIONS: Practicing anesthetists care about potential neurotoxicity of anesthetic drugs in young children. Colleagues working in children's hospital have slightly different attitudes to deal with the topic, compared to those working in general hospitals. The vast majority of our colleagues are waiting for prospective human research data that may help to unravel the current controversy surrounding potential anesthetic drug neurotoxicity and help to improve the safety of pediatric anesthesia.