Illustration by Liz Lundblade
Newborns and young children often require surgery to correct serious birth defects or to treat emergency injuries. These procedures cannot be done safely or ethically without anesthesia.
About 20 years ago, controversy began about whether anesthesia could harm the brains of very young children. I had learned about mouse and rat studies which showed that certain anesthetic drugs cause the death of brain cells of young animals. As a neurologist, I was quite concerned because young brains are especially vulnerable, and early injury can affect learning and memory later in life.
At that time, anesthesiologists were not willing to change how anesthesia was performed based only on rodent studies. Children still needed anesthesia and withholding anesthesia is not possible. Doctors and scientists in the field needed to better understand what could be done to fix this problem. What was missing was evidence from a model that more closely resembled human brain development. Together with other doctors at OHSU and Washington University St. Louis and scientists at the Oregon National Primate Research Center, we conducted carefully designed studies in a small number of monkeys. This work was done with great care, oversight, and a clear medical purpose to determine whether anesthesia might be toxic to the developing brain.
The studies had an enormous impact. We learned that several critical types of brain cells in the newborn brain were indeed killed by anesthesia. The findings prompted anesthesiologists around the world to rethink how anesthesia is performed, and we now treat children very differently. Over the years, new techniques, drug combinations, and monitoring approaches have been developed to better protect the developing brain. Today, pediatric anesthesia is significantly safer because of these studies.
Even with modern technology, laboratory models like organoids or artificial intelligence cannot yet replicate the complexity of a developing primate brain. They cannot fully predict how drug exposure affects cell death, brain circuits, blood flow, metabolism, or long-term development. For rare but essential questions like this, questions that directly affect how we treat and protect children, primate research remains a critical need.
— Dr. Stephen Back, OHSU Doernbecher Children’s Hospital
(Dr. Stephen Back is a Professor of Pediatrics and also works on staff at Shriner’s Hospital in Portland, OR. His research is supported by the March of Dimes and the American Heart Association as well as the NIH)