Use of anesthetics in young children Consensus statement of the European Society of Anaesthesiology (ESA), the European Society for Paediatric Anaesthesiology (ESPA), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Safe Tots Anaesthesia Research Initiative (EuroSTAR).

Experimental studies have shown that general anesthetics may cause a variety of morphological changes in developing immature brain of laboratory animals (1). Additionally, there is some evidence that longterm and prolonged exposure may be worse than short-term exposure in some animal species (2,3). However, the relevance of these findings in human beings is currently unknown (4,5) and studies have shown controversial results (6–8). While a number of investigations in humans have demonstrated an association between surgical and anesthetic exposure and negative neurodevelopmental outcome (9–11), several others have been unable to find such an association or only in a minor subset of exposed children with or without extensive individual neurocognitive testing (12–18). It remains, therefore, very difficult to identify whether any negative neurodevelopmental effects are due to anesthetic drugs, the conduct of anesthesia, surgical trauma or the underlying clinical conditions(s) (3–19). Importantly, however, two prospective human studies, with the most robust designs, indicate that short-term single exposure of 60 minutes or less to surgery and anesthesia is not associated with measurable long-term neurodevelopmental problems (12,16).