There is currently much debate on the approach anaesthetists and the wider medical team should take in response to publications about the potential of general anaesthetic agents to cause changes in the developing brain. The debate centres on initial observations in immature animals that a variety of anaesthetic agents including volatile anaesthetic agents, propofol, ketamine and benzodiazepines can induce both cytological, biochemical and behavioural changes after anaesthesia. There have already been many statements published on this topic with wide spectra of opinion and advice which are referenced in the guidance. Several of the documents offer conflicting advice on the “at risk” population, the interpretation of potential harm and advice for anaesthetists on what to discuss with parents and carers before surgery.
In response to requests from the anaesthesia community in UK and Ireland, RCoA has provided a brief summary of key points that aim for clarity and to provide a safe and sensible response to the current knowledge. This does not take the place of a systematic review on the topic and is not intended to present a prescriptive view on anaesthesia in the very young. The guidance has been prepared to help clarify current knowledge and provide a balanced approach to the data. It provides suggestions on how to discuss the subject when it has been brought up by parents. It must be seen within the context of a broad approach to this potential (but as yet unproven) problem and should be adjusted as new information emerges.