The controversy of anaesthesia neurotoxicity in young patients assumes that anaesthetic agents are correctly administered and the conduct of anaesthesia is perfect. However, worldwide healthy children suffer from cardiac arrest, brain damage and death due to inappropriate anaesthesia care. Furthermore, it is not uncommon that young children undergoing general anaesthesia suffer from hypoxia, hypotension, hypocapnia, hyperglycaemia/hypoglycaemia and hyponatraemia, the latter caused by inappropriate perioperative fluid therapy. Each of these entities may lead to serious perioperative cerebral damage and/or even death, and are likely to be responsible for minor cerebral lesions not immediately detectable postoperatively. Years later the consequences are uncovered using sophisticated neuro-cognitive testing, and are then suddenly attributed to anaesthetic agents.
The Safe Anaesthesia For Every Tot Initiative (www.safetots.org) illustrates the known perioperative causes for cerebral morbidity in young children, addresses the gaps in regulations, teaching, supervision and research in paediatric anaesthesia care and aims to define the ‘who‘, ‘where‘, ‘when‘ and ‘how’ for the safe conduct of paediatric anaesthesia.