- Is general anesthesia to be avoided in children?
- Regional anesthesia offers a viable alternative in most surgical cases.
- It is appropriate to examine the clinical wisdom of administering central anesthesia in a child when regional is equally or more effective.
- Regional anesthesia offers profound analgesia in addition to anesthesia, reducing the need for strong oral analgesics.
General anesthesia may impair language learning in children, according to a study published recently in Pediatrics.
The Pediatrics study “compared healthy participants of a language development study at age 5 to 18 years who had undergone surgery with anesthesia before 4 years of age (n = 53) with unexposed peers (n = 53) who were matched for age, gender, handedness, and socioeconomic status.”
The researchers from the University of Cincinnati evaluated neurocognition using the Oral and Written Language Scales and the Wechsler Intelligence Scales (WAIS) or WISC, as appropriate for age. Brain structural comparisons were conducted by using T1-weighted MRI scans.
“The present findings suggest that general anesthesia for a surgical procedure in early childhood may be associated with long-term diminution of language abilities and cognition, as well as regional volumetric alterations in brain structure,” the authors wrote.
“There may be a theoretical risk during anesthesia exposure, but necessary surgeries should still be performed,” Andreas Loepke, MD, PhD, told Reuters Health. Dr. Loepke is Specialist in Anesthesia in the Department of Anesthesiology at Cincinnati Children's Hospital
The Alternative: Regional Anesthesia
Previous studies have shown no cognitive impairment following regional anesthesia. A 2014 study published in Anesthesia & Analgesia found no link between duration of surgery in an infant under spinal anesthesia and scores on academic achievement tests in elementary school. “We also found no relationship between infant [spinal anesthesia] and surgery with [very poor academic achievement] on elementary school testing,” the authors wrote.
A 2013 study published in Pediatric Anesthesia found that the “odds of a formal diagnosis of learning disability by age 12 years in apparently healthy children exposed to general anesthesia for minor surgery during infancy were 4.5 times greater than their peers who had never been exposed to anesthesia.”
Controversial Findings
According to the Reuters Health article, “The results of the study do not provide sufficient evidence to warrant any changes in practice or anesthesia in children, whether it be delaying procedures to avoid exposure or changing type of anesthetics,” said Lena Sun, MD, Emanuel M. Papper Professor of Anesthesiology, Vice Chair, Department of Anesthesiology, and
Chief of the Division of Pediatric Anesthesiology at Columbia University Medical Center in New York.
Even so, the study does highlight the need for more research to understand the long-term effects of exposing children to anesthesia, said Dr. Sun, who wasn't involved in the research.
Animal studies have suggested that anesthesia can effect the developing brain, said Dr. Robert Williams, Professor of Anesthesiology and Pediatrics at the University of Vermont.
“All of our anesthesia and sedative agents seem to cause loss of brain cells along with learning and memory issues in laboratory animals,” Williams, who wasn't involved in the study, said by email. “We don't know for sure what if anything these effects mean for humans.”
