Millions of children undergo surgical operations and painful interventions with general anesthesia every year. Animal research has demonstrated structural and functional consequences following exposure early in life. Epidemiological studies have associated early childhood anesthetic exposure for surgery with subsequent neurobehavioral abnormalities. Combined, these findings have raised substantial concerns that anesthetics may interfere with brain development in humans. However, several important questions remain unresolved, such as whether structural abnormalities occur in humans, the exact neurocognitive phenotype following exposure, whether age during exposure affects vulnerability, and if there even exists a safe age after which the brain becomes resistant to long-term alterations by anesthetics. Complicating this discussion is the fact that anesthetics also protect the immature brain from the noxious effects of stress, pain, and ischemia. Accordingly, this review discusses the current state of research into this ambiguity, the yin and yang of anesthetic effects on the developing brain.
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