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General anesthesia risk across pediatric surgical specialties: Low in otolaryngology

Caroline M Kolb1, Dee Tinley-Strong2, Rajiv Rangarajan2

  • 1Department of Otolaryngology, Fort Belvoir Community Hospital, 9300 Dewitt Loop, Fort Belvoir, VA, 22060, USA.

International Journal of Pediatric Otorhinolaryngology
|November 23, 2019
PubMed

Insights

Few young children require general anesthesia for over 3 hours. This study assesses FDA warning relevance for pediatric surgery, balancing anesthesia risks against necessary interventions for children under 3.

Area of Science:

  • Pediatric Anesthesiology
  • Surgical Outcomes
  • Regulatory Science

Background:

  • The FDA issued a warning regarding general anesthesia (GA) in children under 3 years for procedures exceeding 3 hours.
  • Assessing the clinical relevance of this warning across surgical specialties is crucial.

Purpose of the Study:

  • To evaluate the frequency of prolonged GA (>3 hours) in children under 3 years.
  • To determine the relevance of the FDA warning by surgical specialty, with a focus on otolaryngology.

Main Methods:

  • Retrospective review of 1 year of data at a tertiary care center.
  • Included children <3 years undergoing procedures >3 hours.
  • Collected data on age, surgical service, procedure type, ASA status, and GA duration.

Main Results:

  • 3.7% of 11,757 patients met criteria (n=430).
  • Prolonged GA was most common in cardiothoracic (46.6%) and neurosurgery (12.9%).
  • Otolaryngology procedures rarely required prolonged GA (<0.5%).

Conclusions:

  • Less than 4% of pediatric patients (<3 years) require GA >3 hours.
  • Balancing theoretical GA risks against the neurodevelopmental impact of delayed critical surgery is essential.
  • A strategy for managing parental and provider concerns regarding prolonged GA is discussed.
Abstract

Keywords:
AnesthesiaFDANeurodevelopmentPediatric surgery

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