Paediatric anaesthesia and the developing brain.

Abstract

Concerns persist regarding the potential long-term effects of general anaesthesia on brain development in children. This narrative review summarises recent preclinical and clinical evidence (2019-25) and updates consensus messages. Preclinical studies show that commonly used anaesthetic agents can interfere with neurodevelopmental processes during vulnerable developmental periods. Clinical evidence is less clear. Randomised trials indicate that a single, short exposure in infancy is not associated with measurable impairment in cognitive outcomes, whereas observational studies report mixed findings. Several large population-based studies consistently identified a small, increased risk of attention-deficit hyperactivity disorder following early exposure to general anaesthesia. Emerging evidence also suggests modifications in visual development and processing, including preferential processing of global visual information, although these findings remain preliminary. Interpretation is limited by confounding related to surgery, comorbidity, and environmental factors. Communication with families should emphasise acknowledgment of parental concerns, individualised anaesthetic care, physiological stability, and that necessary procedures should not be delayed because of theoretical neurodevelopmental risks.