The impact of early exposure to general anesthesia on visual and neurocognitive development

Surv Ophthalmol. 2023 May-Jun;68(3):539-555. doi: 10.1016/j.survophthal.2022.08.006. Epub 2022 Aug 12.


Every year millions of children are exposed to general anesthesia while undergoing surgical and diagnostic procedures. In the field of ophthalmology, 44,000 children are exposed to general anesthesia annually for strabismus surgery alone. While it is clear that general anesthesia is necessary for sedation and pain minimization during surgical procedures, the possibility of neurotoxic impairments from its exposure is of concern. In animals there is strong evidence linking early anesthesia exposure to abnormal neural development. but in humans the effects of anesthesia are debated. In humans many aspects of vision develop within the first year of life, making the visual system vulnerable to early adverse experiences and potentially vulnerable to early exposure to general anesthesia. We attempt to address whether the visual system is affected by early postnatal exposure to general anesthesia. We first summarize key mechanisms that could account for the neurotoxic effects of general anesthesia on the developing brain and review existing literature on the effects of early anesthesia exposure on the visual system in both animals and humans and on neurocognitive development in humans. Finally, we conclude by proposing future directions for research that could address unanswered questions regarding the impact of general anesthesia on visual development.

Keywords: Anesthesia Neurotoxicity; Early Development; General Anesthesia; Neurocognitive Development; Neurodevelopment; Optic Nerve; Retina; Visual Cortex; Visual Development.

Publication types

  • Review

MeSH terms

  • Anesthesia, General* / adverse effects
  • Animals
  • Brain*
  • Child
  • Humans