Reader response

Myron Yaster MD

From David O. Warner MD, Professor of Anesthesiology, Mayo Clinic, Rochester, Minnesota

I enjoyed the review of the excellent article on the potential for heath disparities in neurodevelopmental outcomes following early anesthetic exposure:

Eisler L, Knapp A, Griffiths KK, Houck CS, Nafiu OO. Neurodevelopmental Outcomes Following Early Childhood Anesthetic Exposure: Consideration of Perioperative Health Disparities. J Neurosurg Anesthesiol. 2025 Jan 1;37(1):138-140. doi: 10.1097/ANA.0000000000000995. Epub 2024 Dec 2. PMID: 39882899

However, this article did not mention the one analysis that sought such disparities – and found them. Shi et al (Br J Anaesth 127:722-728, 2021) found that non-white children were at greater risk to develop ADHD after exposure to anesthesia and surgery compared to white children. For those with multiple exposures prior to age 5, the hazard ratio for developing ADHD was 1.62 (1.51, 1.79 [95% CI]) for white children compared with 2.23 (1.89, 2.63) for non-white children. Although such analyses may not currently be politically fashionable (and may be banned), this and other perioperative health disparities are real, and must be both understood and addressed.

From Rita Agarwal MD, FAAP, FASA, (she/her), Clinical Professor of Anesthesiology, Stanford University on sugammadex and changing how we use NMB agonists

It has impacted how I conduct my anesthetics.

I use more muscle relaxant than I used to in children < 3 years of age. I use it so that I don’ t have to use high doses of anesthetic to get a patient deep enough for intubation or to prevent movement. I also use a lot more dexmedetomidine for a variety of reasons, but one of the reasons is that it has been shown to be neuroprotective in animal studies. I also love dexmedetomidine wake ups and analgesic effects.