Some studies show that general anesthesia may have a long lasting effect on a child’s brain development, even years after surgery – but do we know for sure? Recent evidence found by the Cincinnati Children’s Hospital suggests that children under the age of four undergoing surgery may risk impairment of their developing brain. According to the Food and Drug Administration, more than a million children undergo surgery each year in the United States.
Concerns about anesthesia’s effects on children grew in the 1990s when studies showed that baby rats had long-term behavioral problems after being exposed to anesthetics. Concern heightened after monkeys showed similarly diminished learning and memory ability.
The recent study by the Cincinnati Children’s Hospital (CCH) comparing IQ scores and language comprehension of 53 healthy participants, aged five to 18 years, to test scores of 53 children who underwent surgery before the age of four produced startling results.
The children who had undergone surgery showed significantly lower performance results, allowing for gender and socioeconomic status. The researchers noted that although the results were lower, the children still remained within the population norm.
The studies done by the Cincinnati Children’s Hospital showed that a young brain under anesthesia is vulnerable to impaired development. In a recent article published by HealthDay News, Dr. Andreas Loepke, a professor of clinical anesthesia and pediatrics at the University Of Cincinnati College Of Medicine said, "The very receptors that anesthetics act on to produce unconsciousness during surgery are also important for stimulating neurons to form proper connections and to survive." Loepke continued to say, "Anesthetic exposure may interfere with normal brain development."
Another study published in the journal Pediatrics stated that the brain structure of the children who had surgery had a lower gray matter density in the occipital cortex and the cerebellum.
According to Medical Daily, researchers say that more information is needed on the cause and effect of anesthesia cell-related death. "Research shows that if you're exposed to these agents during the time neurons are growing, it disrupts their development," stated Dr. Jeffrey Silverstein, professor of Anesthesiology, Surgery and Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York City.
Can the loss of gray matter density lead to a lifetime of potential economic problems for these children? There is research that correlates the loss of a single IQ point to a decrease in a person’s lifetime earnings of $18,000. According to the CCH study, there was a potential loss of five to six points. The comprehensive effect of six million pediatric surgeries each year equates to a potential loss of $540 billion in earned income.
Unfortunately, pediatric surgery is often unavoidable. In many cases, children are fighting life-threatening conditions that require surgery, which obviously involves anesthetics.
Anesthesiologists and surgeons already make sure patients have as limited exposure as possible to anesthetics during surgery, The FDA and the International Anesthesia Research Society formed a non-profit named SmartTots, a multi-year collaborative effort focused on increasing the safety of anesthetic drugs for the children who undergo surgery, and their studies will form new practice guidelines on anesthetics.
SmartTots has issued a statement, still in draft form and not yet approved by the FDA, stating that if an operation requiring anesthesia and sedative drugs can reasonably be delayed, it “should possibly be postponed because of the potential risk to the developing brain of infants, toddlers and preschool children.”
There is evidence that animals exposed to anesthesia, then placed in a stimulating environment, will recover from adverse anesthetic effects. Although we cannot directly compare a human reaction to an animal’s, there is still an association that can be made from these studies. Minimizing the amount of anesthetics used on children, and keeping them pain free is the goal of each surgery.
As doctors compare animal studies and the recent Cincinnati Children’s Hospital study, the next step in the research process will discover if there are alternatives in types of anesthesia that will lessen negative effects on the developing brain. Surgery on children is often the best and only solution when it comes to life-threatening issues. The next hurdle is making sure these surgeries won’t affect their later cognitive development.
Are there techniques or guidelines that will reduce the risk of brain damage? Would replacing general anesthesia with regional anesthesia be a viable option? Will new anesthetics be developed that can protect the brain?
How do we keep our children from suffering a second adverse condition after solving the first? Existing best practices of anesthesia are currently our best option, but more research is required.
Let us know what you think. Do you have solutions to offer?