To the Editor:

We read with great interest the recent editorial concerning anesthetic neurotoxicity by Drs. Vutskits and Culley.1  We agree with their interpretation that it appears a short exposure to general anesthesia is unlikely to cause clinically significant neurocognitive deficits in our youngest patients. However, for our group, choosing a form of awake regional anesthesia for appropriate surgeries has never been about the theoretical risk of neurotoxicity. Rather, it involves a conscious choice to work as a joint surgical and anesthetic team to provide a technique that has a proven lower risk of hypotension, apnea, bradycardia and laryngospasm while producing lower pain scores in the postanesthesia care unit and shorter anesthesia control times.2 

Although we are in alignment with most of the authors’ main points, we must take exception to the overall picture of awake regional anesthesia in infants that the authors have portrayed. An awake infant with “no sedation, no mom or dad and instead a pediatric anesthesiologist providing sucrose on a pacifier to calm you” is not representative of our joint experience with 3,000 infants undergoing spinal anesthesia. Within 10 min of induction, most infants enter a state of sedation resembling phenotypically normal sleep. If necessary, we calm infants with stroking, soothing, and offer concentrated sucrose solution on a pacifier. If needed, we will administer small doses of intravenous sedation; however, this is required in less than 20% of cases, which is also representative of the experience of other investigators.2  Awake regional anesthesia has numerous benefits and can be administered in a humane, patient-centered fashion while providing excellent surgical operating conditions.

Competing Interests

The authors declare no competing interests.

References

1.
Vutskits
L
,
Culley
DJ
: .
GAS, PANDA, and MASK: No evidence of clinical anesthetic neurotoxicity!
Anesthesiology
.
2019
;
131
:
762
4
2.
McCann
ME
,
Withington
DE
,
Arnup
SJ
,
Davidson
AJ
,
Disma
N
,
Frawley
G
,
Morton
NS
,
Bell
G
,
Hunt
RW
,
Bellinger
DC
,
Polaner
DM
,
Leo
A
,
Absalom
AR
,
von Ungern-Sternberg
BS
,
Izzo
F
,
Szmuk
P
,
Young
V
,
Soriano
SG
,
de Graaff
JC
;
GAS Consortium
: .
Differences in blood pressure in infants after general anesthesia compared to awake regional anesthesia (GAS study-A prospective randomized trial).
Anesth Analg
.
2017
;
125
:
837
45