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For clinicians

Children and anesthesia: what the brain-development studies found

What trials and studies show about anesthesia in young children, what the FDA labels say, and how children's sedation is kept safe.

3 minute read, written for clinicians6 sources, each checked word for wordLibrary checked October 18, 2026

A hand holding a stethoscope to a teddy bear's back

This is the clinician view. It keeps every sentence of the plain guide and adds, for each section, the study design and citations of its sources. Every added sentence is cited and checked like the rest. Back to plain language.

In short

  • Slightly less than 1 hour of general anesthesia in early infancy did not change development at age 5 compared with awake-regional anesthesia.E1Strong1
  • Healthy children with a single anesthetic before age 3 had IQ scores similar to their siblings later in childhood.E2Good2
  • Repeated and long exposures still need more study.E2Good2

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades meanUnderlined words open a definition

Does anesthesia affect the developing brain?

In the GAS trial, slightly less than 1 hour of general anesthesia in early infancy did not alter neurodevelopment at age 5 compared with awake-regional anesthesia. The study population was mostly male.E1Strong1

The PANDA study compared healthy children who had a single anesthetic before 36 months with healthy siblings who had none. In later childhood, there was no significant difference in IQ.E2Good2

The sevoflurane label says the clinical significance of animal findings is not clear. It says the window of vulnerability is believed to start in the third trimester of pregnancy. It is believed to run through the first several months of life, possibly to about age 3.Official text3

The evidence in this section (3 sources)
SourceDesignGradeCitations (NIH iCite)
1 McCann ME, Lancet, 2019Randomized trialE1Strong526 (RCR 33.14)
2 Sun LS, JAMA, 2016Observational studyE2Good678 (RCR 33.03)
3 AbbVie Inc., 2025FDA labelOfficial textNot tracked

Fasting and sedation for children

European guidelines encourage children, like adults, to drink clear fluids up to 2 hours before elective surgery.E2Good4

The ASA's 2023 fasting update addressed how long children fast.E2Good5

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry describe safe sedation as a system. It includes no sedating medicine without medical or dental supervision and a careful check of conditions that raise risk. It also includes appropriate fasting and an airway exam for large tonsils or other problems.E2Good6

Their guidance adds staff trained to rescue the airway, age- and size-appropriate equipment, and reversal medicines. It calls for enough trained staff to do the procedure and watch the child, and monitoring during and after. It also calls for a staffed recovery area, and recovery to the child's usual alertness before going home.E2Good6

The evidence in this section (3 sources)
SourceDesignGradeCitations (NIH iCite)
4 Smith I, Eur J Anaesthesiol, 2011GuidelineE2Good584 (RCR 25.03)
5 Joshi GP, Anesthesiology, 2023GuidelineE2Good252 (RCR 46.44)
6 Coté CJ, Pediatrics, 2019GuidelineE2GoodNot tracked

What is not known yet

Further study of repeated exposure, long exposure and vulnerable groups of children is needed.E2Good2

Questions you might bring to your anesthesia team

  1. How long will my child be under anesthesia, and is more than one anesthetic planned?
  2. Who will monitor my child, and what training and equipment are in place?
  3. What are the fasting times for my child, and can they drink clear fluids?
  4. Can I be there when my child goes to sleep and wakes up?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. McCann ME, Lancet, 2019. E1Strong Randomized trialPMID 30782342; DOI 10.1016/S0140-6736(18)32485-1; cited 526 times, relative citation ratio 33.14 (NIH iCite, 2026-10-18)
    The words this page rests on
    Slightly less than 1 h of general anaesthesia in early infancy does not alter neurodevelopmental outcome at age 5 years compared with awake-regional anaesthesia in a predominantly male study population.
  2. Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. Sun LS, JAMA, 2016. E2Good Observational studyPMID 27272582; DOI 10.1001/jama.2016.6967; cited 678 times, relative citation ratio 33.03 (NIH iCite, 2026-10-18)
    The words this page rests on
    Among healthy children with a single anesthesia exposure before age 36 months, compared with healthy siblings with no anesthesia exposure, there were no statistically significant differences in IQ scores in later childhood. Further study of repeated exposure, prolonged exposure, and vulnerable subgroups is needed.
  3. ULTANE (sevoflurane) volatile liquid for inhalation, Prescribing Information. AbbVie Inc., 2025. Official text FDA label
    The words this page rests on
    The clinical significance of these findings is not clear. However, based on the available data, the window of vulnerability to these changes is believed to correlate with exposures in the third trimester of gestation through the first several months of life, but may extend out to approximately three years of age in humans (see PRECAUTIONS - Pregnancy, PRECAUTIONS - Pediatric Use, ANIMAL TOXICOLOGY AND/OR PHARMACOLOGY).
  4. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Smith I, Eur J Anaesthesiol, 2011. E2Good GuidelinePMID 21712716; DOI 10.1097/EJA.0b013e3283495ba1; cited 584 times, relative citation ratio 25.03 (NIH iCite, 2026-10-18)
    The words this page rests on
    The key recommendations are that adults and children should be encouraged to drink clear fluids up to 2 h before elective surgery (including caesarean section) and all but one member of the guidelines group consider that tea or coffee with milk added (up to about one fifth of the total volume) are still clear fluids.
  5. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Joshi GP, Anesthesiology, 2023. E2Good GuidelinePMID 36629465; DOI 10.1097/ALN.0000000000004381; cited 252 times, relative citation ratio 46.44 (NIH iCite, 2026-10-18)
    The words this page rests on
    These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration.
  6. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Coté CJ, Pediatrics, 2019. E2Good GuidelinePMID 31138666
    The words this page rests on
    The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction,
    This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.
    appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of appropriately trained staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions.