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Published on: May 12, 2018
Clinical update regarding general anesthesia-associated neurotoxicity in infants and children
1Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Recent studies indicate that general anesthesia for healthy young children is unlikely to cause neurodevelopmental issues. Concerns about anesthesia
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Pediatrics
- Public Health Policy
Background:
- U.S. FDA issued a warning regarding potential neurodevelopmental effects of anesthesia in young children.
- Concerns center on repeated or lengthy exposure in children under 3 and pregnant women in the third trimester.
Purpose of the Study:
- To review recent clinical studies addressing FDA concerns on anesthesia and neurodevelopment in young children.
- To evaluate the evidence regarding potential adverse neurodevelopmental outcomes from anesthesia in healthy pediatric populations.
Main Methods:
- Review of three large retrospective matched cohort studies.
- Analysis of data from 59,814 children exposed to general anesthesia before age 4.
- Inclusion of data on 30,021 children under 2 years and 9,814 with multiple exposures.
Main Results:
- No association found between anesthesia exposure (single or multiple) and adverse neurodevelopmental consequences in children under 4.
- Biological, environmental, and social factors were identified as more significant influences on neurodevelopment.
- Findings suggest anesthetic neurotoxicity is not a primary concern for most healthy children undergoing surgery before age 3.
Conclusions:
- Anesthetic neurotoxicity is unlikely to be a major factor in adverse neurodevelopmental outcomes for the majority of healthy young children.
- Future research should investigate specific vulnerable populations like fetuses, premature infants, and children with significant medical conditions.
- The current evidence suggests current anesthesia practices are safe for healthy children requiring surgery.
Purpose Of Review:
The U.S. Federal Drug Administration (FDA) recently released a warning stating that 'repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains' (www.fda.gov/ucm582356.htm). The goal of this article is to review the most recent clinical studies which provide evidence that these concerns may be overstated for the majority of healthy young children who require surgery and anesthesia.
Recent Findings:
Three large retrospective matched cohort studies published within the past year provide data on a total of 59 814 children exposed to general anesthesia before age 4 (including 30 021 <2 years and 9814 multiple exposure). All three studies independently conclude that neither exposure to anesthesia in children under 2 years of age nor multiple exposures are associated with adverse neurodevelopmental consequences in the patient populations studied. Biological, environmental, and social factors were found to be of far greater import.
Summary:
These findings suggest that anesthetic neurotoxicity is not a major contributory pathway for adverse neurodevelopmental outcomes in the majority of healthy children who require surgery before 3 years of age. Future work should focus on the particular vulnerabilities of the fetus, premature infant, and children with developmental disabilities, major congenital, cardiac or neurological abnormalities not specifically addressed by these studies.
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