**Author details**

anesthesia before the age of 3 were excluded from the study. Children classified as having single, multiple, or no anesthesia exposure were evaluated between the years 2007 and 2016, when they were at the age of 8–12 or 15–19 with a single session that lasted for 4 hours using the National Center for Toxicological Research-Operant Test Battery (NCTR-OTB). The NCTR-OTB test evaluates processing speed; cognitive/intellectual memory; attention, language,

The Pediatric Anesthesia and Neurodevelopmental Assessment (PANDA), which was conducted by the University of Columbia and followed sibling pairs under the age of 3 who underwent inguinal operation up to the age of 8–15, published four symposiums in 2-year interval. The first meeting in 2008 established the goals of the study. The second meeting in 2010 was interdisciplinary. The third meeting in 2012 was attended by different disciplines, parents, clinicians, FDA workers, and patient's rights advocates. In this meeting, attendees agreed to collaborate on advanced preclinical, clinical, and translational studies [75, 76]. Additionally in 2012, pediatric anesthesiologists and pediatric surgeons met to discuss the neurotoxicity risk of some elective procedures and anesthesia applications performed in children and specifically to discuss questions and concerns of parents. Meeting attendees, including pediatric general surgeons, urologists, plastic surgeons, and ophthalmologists, reviewed inguinal hernia, hypospadias-undescended testis, cleft lip, craniosynostosis, cataracts, and strabismus applications in early childhood. They emphasized that the amount of volatile anesthetics and sedation levels could be reduced by using balanced anesthesia methods, regional anesthesia methods, and the use of opioid and non-opioid analgesics, but the group was unable to reach a consensus on best practices [77]. At the 2014 meeting, the existing clinical studies, General Anesthesia Study (GAS), MASK, and PANDA, were evaluated, and Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots (SmartTots) was presented along with the future targets of this organization. SmartTots is a public-private partnership that investigates the effects of anesthetic agents on neural development in infants and children. All panelists evaluated their anesthesia and clinical practices with the following

motor and visual-spatial, and cognitive processing; and executive functions [74].

questions [78, 79]:

110 Current Topics in Anesthesiology



Will I change my practice and how?


A child requiring multiple procedures under GA overtime.

A child requiring multiple procedures from different subspecialties at the same time.

The 2014 report indicated that the collected data was insufficient to draw any conclusions. However, it stated 2 years later that the results would be considered as a public health problem, leading to greater awareness [78]. On the other hand, the General Anesthesia Study Ayse B. Ozer\* and Sibel Ozcan

\*Address all correspondence to: abelinozer@gmail.com

Faculty of Medicine, Department of Anesthesiology Intensive Care, Firat University, Elazig, Turkey
