Possible effects of general anaesthetic: neurotoxicity in children?

Mr N mentioned the possible risk of repeated general anaesthesia and neurotoxicity. Below is an article from the British Journal of Anaesthesia that sums up the current research.

If we have the serial casting at Oxford, J will have GA every 3 months from about 22 to 40 months.

The author points out problems with the different studies (eg small numbers in cohorts or changes in anaesthetic practice), but it's still a chilling read as a parent about to subject a child to repeated GA at such a vulnerable age... 

Early childhood general anaesthesia exposure and neurocognitive development (click for link)

Author: L. Sun

(reference: Br. J. Anaesth. (2010) 105(suppl 1): i61-i68 doi:10.1093/bja/aeq302)

Summary

A great deal of concern has recently arisen regarding the safety of anaesthesia in infants and children. There is mounting and convincing preclinical evidence in rodents and non-human primates that anaesthetics in common clinical use are neurotoxic to the developing brain in vitro and cause long-term neurobehavioural abnormalities in vivo. An estimated 6 million children (including 1.5 million infants) undergo surgery and anaesthesia each year in the USA alone, so the clinical relevance of anaesthetic neurotoxicity is an urgent matter of public health. Clinical studies that have been conducted on the long-term neurodevelopmental effects of anaesthetic agents in infants and children are retrospective analyses of existing data. Two large-scale clinical studies are currently underway to further address this issue. The PANDA study is a large-scale, multisite, ambi-directional sibling-matched cohort study in the USA. The aim of this study is to examine the neurodevelopmental effects of exposure to general anaesthesia during inguinal hernia surgery before 36 months of age. Another large-scale study is the GAS study, which will compare the neurodevelopmental outcome between two anaesthetic techniques, general sevoflurane anaesthesia and regional anaesthesia, in infants undergoing inguinal hernia repair. These study results should contribute significant information related to anaesthetic neurotoxicity in children.