Early childhood anesthesia not linked to developmental problems


By Lisa Rapaport

(Reuters Health) – Young children who underwent surgery under general anesthesia were not more likely than their siblings who were not exposed to anesthesia to address development challenges that hamper school readiness, a Canadian study has found.

Some earlier studies suggest that the opposite may be true: that the developing brain may be injured by anesthetic drugs early in life, the researchers note in JAMA Pediatrics. But much of this research was based on studies in animals and laboratories, not on children undergoing surgery.

For the current study, the researchers examined data from nearly 11,000 pairs of siblings, including about 370 pairs with both siblings exposed to surgery under general anesthesia and approximately 2,350 pairs with only one sibling with anesthetic exposure.

Although children exposed to anesthesia seemed to have a slightly greater risk of developing physical health problems or challenges in social, emotional, or communication skills than their siblings who did not undergo surgery, these differences were too small to rule out the possibility that they were due to chance, since the researchers took into account the age of the children during surgery and other factors that may also affect the development.

"The findings of this study should reassure the parents of young children who need anesthesia for surgical procedures," said study lead author Dr. James D. O & # 39; Leary, an anesthesiologist at the Hospital for Sick Children (SickKids) in Toronto and the University of Toronto.

"However, interpreting the clinical implications of anesthetic-related neurotoxicity is challenging, and more definitive clinical studies providing high-quality evidence of a relationship between anesthesia exposure and neurological injury are still needed to guide treatment decisions," said O & # 39; Leary by email. .

Most children who underwent surgery – about 60% – were at least two years old at the time of their operations and most – almost 80% – had no overnight stay.

The most common procedures included operations to correct problems with the ears, mouth and throat, male genital organs, or musculoskeletal system.

In pairs with one brother who had surgery and another who did not, there was no difference in the proportion of children who had delays in cognitive and language development, social skills, emotional health and maturity, or communication skills.

The study included all children eligible for public or Catholic schools in Ontario, Canada, from 2004 to 2012.

The researchers examined data from a questionnaire that teachers filled out to assess child development before children entered primary school when they were between five and six years of age.

A disadvantage of the study is that it was not a controlled experiment designed to prove whether or how exposure to general anesthesia during surgery can directly impact the development of the brain in early childhood. Another limitation is the analysis of excluded children with assessments that pointed to possible behavioral, learning or development problems.

Parents of children who need surgery should still be reassured by the results, said Dr. Andrew Davidson of the Royal Children's Hospital and the Murdoch Children's Research Institute in Melbourne, Australia.

"This study adds to the growing data that for the vast majority of cases, anesthesia has no impact on school readiness and this should be added to the fact that we increasingly think that in most cases it has no impact on cognition and many other aspects of neurodevelopment, "said Davidson, who was not involved in the study.

But there are still some studies linking anesthesia to some behavioral problems, Davidson warned.

"Based on this study and others, parents whose children are healthy should not delay the necessary procedures that may require anesthesia," said Lena Sun, chief of pediatric anesthesiology at Morgan Stanley Children's Hospital and a specialist at the University Medical Center. Columbia in New York. City.

"However, research is still needed to identify subgroups of children who may have developmental vulnerability to exposure to anesthesia," said Sun, who did not participate in the study by e-mail.

SOURCE: http://bit.ly/2PC1tP5 JAMA Pediatrics, online November 5, 2018.


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