Neurodevelopmental Impact of Anesthesia in Early Childhood: A Narrative Review

The neurodevelopmental impact of early childhood exposure to general anesthesia (GA) remains debated. While preclinical studies suggest prolonged GA exposure may disrupt neuronal development, translating these findings to humans is complex due to confounding factors such as surgical stress, preexisting conditions, and perioperative management. Large cohort studies have shown mixed results, with some indicating cognitive and language impairments, while others report no significant long-term deficits. Randomized controlled trials suggest a single, brief GA exposure does not cause measurable neurodevelopmental impairment, whereas repeated exposures may increase the risk of cognitive and behavioral deficits. Systematic reviews support these findings, highlighting an increased likelihood of neurodevelopmental delays following multiple exposures, particularly affecting language proficiency, executive function, and adaptive behavior, though the clinical significance remains uncertain. Factors such as specific anesthetic agents, cerebral perfusion, and inflammatory responses may influence outcomes. Alternative strategies, including opioid-free anesthesia and regional techniques, have been explored to mitigate potential risks, but current evidence remains inconclusive. Given the heterogeneity of existing studies, further high-quality research is needed to clarify the long-term effects of pediatric anesthesia on neurodevelopment and identify protective strategies. © 2025 Bali Journal of Anesthesiology.