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An overwhelming angst of anesthesia-related neurotoxicity in small children has gripped the pediatric anesthetic community in the past decade culminating in a FDA suggestion that general anesthetic agents may not be safe in children younger than 4 years of age. (1-3) Considerable financial and personal resources have been and are currently still invested into this research. This includes laboratory, animal experimental as well as retro- and prospective human studies. Initial results in humans are now available and continuously updated and summarised by the FDA endorsed SmartTots initiative. (www.smarttots.org) No definite causal link between certain anesthetic drugs or techniques and poor neurological outcome in children has been established to date. (4-7) However, there is a documented relationship between the conduct of anesthesia and catastrophic neurological outcome or even mortality in small children. (8)  
Safetots.org initiative addresses the teaching, training, education and supervision of the safe conduct of pediatric anesthesia.
1. Rappaport B, Mellon RD, Simone A, Woodcock J. Defining safe use of anesthesia in children. N Engl J Med. 2011; 364: 1387-90. 2. Jevtovic-Todorovic V Hartman RE, Izumi Y, Benshoff ND, Dikranian K, Zorumski CF, Olney JW, Wozniak DF. Early exposure to common anesthetic agents causes     widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003; 23: 876-82. 3. http://www.fda.gov/downloads/forconsumers/consumerupdates/ucm364244.pdf (August 2013). 4. Sanders RD, Hassell J, Davidson AJ, Robertson NJ, Ma D. Impact of anesthetics and surgery on neurodevelopment: an update.     Br J Anaesth. 2013; 110 Suppl 1: i53-72. 5. Hansen TG. Anesthesia-related neurotoxicity and the developing animal brain is not a significant problem in children. Paediatr Anaesth. 2015; 25: 65-72. 6. Hansen TG. Neurotoxicity, general anesthesia, and the developing brain: what have we learned from the human studies so far?     Curr Anesthesiol Rep. 2013; 3: 175–83. 7. Jevtovic-Todorovic V, Absalom AR, Blomgren K, Brambrink A, Crosby G, Culley DJ, Fiskum G, Giffard RG, Herold KF, Loepke AW, Ma D, Orser BA, Planel E,    Slikker W Jr, Soriano SG, Stratmann G, Vutskits L, Xie Z, Hemmings  HC Jr. Anaesthetic neurotoxicity and neuroplasticity: an expert group report and statement based    on the BJA Salzburg Seminar. Br J Anaesth. 2013; 111: 143-51. 8. McCann ME, Schouten AN, Dobija N, Munoz C, Stephenson L, Poussaint T, Kalkman C, Hickey PR. de Vries L, Tasker R. Infantile postoperative encephalopathy:    perioperative factors as a cause for concern. Pediatrics. 2014; 133: e751-7.