We have read with great interest the paper authored by Bartels et. al. (2009) and appreciate the opportunity to comment. We recognize and applaud the efforts of the authors to provide additional insight into what we believe to be among the most pressing issues facing the anesthetic care of children around the world. As was discussed extensively in our recent publication (Wilder et al., 2009), we share the authors concern that any association between early exposure to anesthetic agents and the subsequent development of learning disabilities is potentially related to comorbidity rather than anesthetic exposure per se. Nonetheless, we believe the author’s conclusion that ‘…there is no evidence for a causal relationship between anesthesia administration and later learningrelate
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