Thanks to advances in medicine, premature babies and others born with complications are more likely than ever to live full, healthy lives. But this also means more infants and toddlers will need surgery — and general anesthesia. The potential for long-term ill effects after being exposed to anesthesia that young is now a matter of some concern among anesthesiologists, surgeons and pediatricians. An article published recently in the New England Journal of Medicine by members of SmartTots, a collaboration between the Food and Drug Administration and the International Anesthesia Research Society looking into the issue, called for more research and recommended considering delaying nonurgent surgeries.
The initial question about safety emerged from studies on mice and monkeys, which showed signs of memory and learning disabilities after exposure to some anesthetics and sedatives. The evidence showed that at high doses the drugs can injure brain cells, changing their structure and ability to communicate with one another or even killing them, says Beverley Orser, professor of anesthesiology and physiology at the University of Toronto. Animal studies suggest that the highest risk is when the brain is developing rapidly around the ages of 3 and 4.
All of the research in humans has been observational and retrospective; doctors have simply looked for cognitive impairment in exposed children years later. The results vary. One study suggests that children exposed to anesthesia more than once are almost twice as likely to have learning disabilities and attention deficit hyperactivity disorder; another, that gender and the mother’s educational level are better predictors of success in school than exposure to anesthesia. An ongoing observational study called PANDA (Pediatric Anesthesia and Neurodevelopment Assessment) is examining whether any effects are seen on IQ, motor function, attention, language ability and executive function. It’s way too soon to know whether certain pediatric patients are more at-risk than others, or if any effects fade with time.
Even though the evidence is far from established, parents of children facing surgery may want to raise the issue with their doctor. One question to ask is if the procedure can wait, says Constance Houck, senior associate of perioperative anesthesia at Boston Children’s Hospital. Houck is also chair of the American Academy of Pediatrics’ surgical advisory panel, which is in the early stages of talking with surgeons and other experts to reach a consensus about optimal timing of common procedures. “Not because there’s definitely a problem,” Houck says, but because there are questions. For example, circumcisions performed after the newborn stage require general anesthesia but are not usually time-sensitive.
For many families, delaying surgery isn’t an option. And general anesthesia is necessary for most procedures in fidgety little ones. “We need to look at the overall picture in terms of risks and benefits,” says Lena S. Sun, chief of the pediatric anesthesiology division at New York-Presbyterian Morgan Stanley Children’s Hospital. “The last thing I’d want is a child who needs something done not to have it because it’s an up-in-the-air question.” Ultimately, the decision about whether to proceed should be left up to the surgeon, pediatrician and parents, says Santhanam Suresh, chair of the department of pediatric anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago. “There’s a judgment call. Each and every case is individual.”
Learning about the potential risks of anesthesia on growing brains is important, but it’s also key to understand that effects that might emerge are “relatively modest,” argues Randall Flick, director of the Mayo Clinic’s Children’s Center. “If they were more severe, we would have known this a long time ago because we’ve been using anesthesia for decades.”
Excerpted from U.S. News’ “Best Hospitals 2016,” the definitive consumer guidebook to U.S. hospitals. Order your copy now.
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Should Surgery Wait? How Anesthesia Affects Kids originally appeared on usnews.com
