**2. Neurocognitive damage**

The neurocognitive damage produced by the use of anesthetic agents in immature brains has been well demonstrated in laboratory animal models. The effect of general anesthetics on brain development in children under three years of age can have an impact on the later life of the child. Modifications that have resulted in serious behavioral and memory changes in experimental animals. It is suspected that a similar situation could occur in children who manifest learning disabilities at school age. However, other variables must be taken into account, such as prematurity itself, and concomitant diseases such as seizures, prolonged ventilation in the neonatal intensive care unit, repeated and chronic administration of multiple medications and surgeries. The evidence of such harm in humans, with general anesthetics such as intravenous, hypnotic, and inhaled has been much more difficult to demonstrate. Until today there are two important concepts regarding accelerated apoptosis damage in immature organs; the damage is directly related to the dose and duration of exposure.

The combination of regional anesthesia and general anesthesia makes it possible to reduce the intraoperative exposure of general anesthetics and they are a good alternative for immature NBs. The concept of reversibility of anesthetics is being questioned [1, 3, 4].
