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LETTER TO THE EDITOR

Neurotoxicity of Anesthetic Agents in Children

Department of Anesthesiology; Children's Hospital and Research Center at Oakland; Oakland, CA (Rowe)

To the Editor:

The review article (1) about anesthetic agents in use in the pediatric population can be complimented on many topics: it invites the anesthetic community to work with the FDA on anesthetic agents in use in young children, and it reviews the current literature without being too judgmental. However, I strongly advise any future research in this area to control for some very important factors:

1. When using high doses of anesthetics in any animal population, vital signs, pulse oximetry, and ABG analysis are critical. In reviewing many of the papers quoted, the researchers usually gave high doses of agents without assessing significant confounding variables: hypoxia, hypotension, and hypercarbia. All of these can significantly affect neuroapoptosis.
   
2. As with any toxicity research, using doses in excess of clinically relevant levels is misleading. Just do the same study with two common, but necessary compounds: water and oxygen. It is scientifically invalid to state that since 100 L/kg IV water is lethal, that 1 mL/kg IV water is risky. Or that breathing 21% oxygen is one-fifth as risky as breathing 100%.
   

Neurotoxicity in the infant and child has to be studied with much more control and thought. I encourage dialogue between the FDA and the anesthesia community, but I hope that the editorial boards of medical journals will be more cognizant of the controls necessary in toxicity research.

REFERENCE

1. Mellon RD, Simone A, Rappaport B. Use of anesthetic agents in neonates and young children. Anesth Analg 2007;104:509–20[Abstract/Free Full Text]

This article has been cited by other articles:

				S. L. Shafer Neurotoxicity of Anesthetic Agents in Children Anesth. Analg., September 1, 2007; 105(3): 882 - 883. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Rowe, R. Search for Related Content PubMed PubMed Citation Articles by Rowe, R.