Putting Babies To Sleep
OK, nobody panic. Remain calm and call anesthesia. Or maybe, if you’re 2, don’t call anesthesia. The New England Journal of Medicine on Feb. 25 published an article that warns of an increasing body of evidence suggesting that anesthesia is bad for babies. Denise Grady, a New York Times reporter, said this in her piece yesterday: (http://www.nytimes.com/2015/02/26/health/researchers-call-for-more-study-of-anesthesia-risks-to-young-children.html?ref=health&_r=0)”
“… five experts described a ‘heightened level of concern’ about the potential risks, called the data from animal studies ‘compelling’ and said ‘parents and care providers should be made aware of the potential risks that anesthetics pose to the developing brain.'”
Evidence of this possible risk as been growing since the 1990’s, when the first animal studies came out. In 2009, the F.D.A. and the International Anesthesia Research Society formed Strategies for Mitigating Anesthesia-Related Neurotoxicity in Tots or SmartTots, to futher research this potential problem. In 2012, SmartTots recommended that elective surgery under general anesthesia be avoided in children younger than 3. Here is what SmartTots is saying this year (http://www.smarttots.org):
Infants and very young children who are exposed to anesthesia may experience higher rates of learning disabilities and cognitive difficulties than children who are not exposed to anesthesia, according to research and emerging data presented during the SmartTots: Pediatric Anesthesia Neurotoxicity panel at the International Anesthesia Research Society annual meeting in Vancouver, B.C. “We want to impress upon people that there is a very reliable link between the animal and human data that is rapidly emerging,” said panel moderator Dr. Vesna Jevtovic-Todorovic, M.D., Ph.D., M.B.A., Professor of Anesthesiology and Neuroscience at the University of Virginia Health System and SmartTots Scientific Advisory Board member.
SmartTots warns that “Children younger than 4 years who were exposed to anesthesia for 120 min and longer for at least two times are at high risk.”
So what is this emerging data? Well, it’s mostly primate and rat data at this point. Researchers found, for example, that a single 24-hour episode of ketamine anesthesia results in very long-lasting deficits in brain function in nonhuman primates. Another found that multiple exposures to anesthesia before a monkey is two years old are a risk factor for the development of Attention Deficit Hyperactivity Disorder. Yet a third paper has demonstrated that common anesthetics, alone and in combination, caused damage in the brain of baby rodents, with widespread death of nerve cells. These rats suffered long-lasting problems with learning and memory, which got worse as they aged.
Yikes. Now, as I said before, don’t panic. There are a few things to consider when reading about this stuff.
1. Your toddler getting her tonsils out or ear tube put in is not at risk. Those are 10 minute procedures in otherwise healthy children. Please do not let your kid suffer years of unnecessary infections and possible hearing loss because of concerns over the anesthesia. I know people are going to. Don’t.
2. Very young children exposed to surgeries lasting two or more hours on multiple occasions generally have either severe birth defects or severe injuries of some kind. I’m not sure you can isolate anesthesia as a cause of brain damage in these situations, in which cognitive development is at risk in multiple other ways.
3. I’m not sure what study Dr. Jevtovic-Todorovic is referring to when she talks about a “very reliable link” between nonhuman and human data. There is an ongoing multicenter study sponsored by Boston Children’s Hospital which is studying 650 infants getting inguinal hernia repairs, looking for neurodevelopmental outcomes in kids getting regional anesthesia (a spinal) vs. general anesthesia. Such a study will involve mostly healthy children with anesthetic exposures significantly lower than those SmartTots says are most concerning, but it might help.
4. General anesthesia is not just the drugs we use. It’s also the type of surgery being done, how much blood loss there is, how much oxygen gets to the patient, how much carbon dioxide builds up, how well blood pressure is maintained, and multiple other factors that anesthesiologists monitor very carefully. Many of these things are under our control, but all anesthesia and surgery interferes with these systems to some extent.
And since personal anecdote has been shown to be more effective than statistics, I will tell you that my second child had major thoracic surgery at age 3 days. She was under anesthesia for about 4 hours. She is now a healthy 4 1/2 year old with no signs of any mental problems except persistent four-ishness. Hope this helps.