An estimated 4 million children receive anesthesia every year, not just for surgery but for diagnostic procedures like MRI and CAT scans, but little is known about their effects on the developing brain. A growing body of data from studies in animals suggests that under certain circumstances, such as prolonged anesthesia, these drugs could adversely affect neurologic, cognitive, and social development of neonates and young children.
Anesthesia is both necessary and helpful however, and too little can even be harmful for kids. A landmark study published in the early 1990s found that a newborn’s chance of surviving a heart operation improved dramatically if he was given deep rather than light anesthesia. The stress of pain, it turned out, made surgery riskier.
This week a federal panel met to evaluate growing concerns about whether anesthesia in young children, used in millions of surgical procedures, can in some cases lead to cognitive problems or learning disabilities.
Dr. Bob Rappaport, the Food and Drug Administration’s director of the division of anesthesia and analgesia products wrote in a related article this week:
“These drugs can cause cognitive disturbances in juvenile animals. We don’t know what this means for children at this time. That’s exactly why it’s so critical that we get all of the necessary information.”
Studies in rodents and monkeys have shown that exposure to anesthesia at a very young age, roughly corresponding to under age 4 in humans, is associated with brain cell death. And a new study, by the F.D.A.’s National Center for Toxicology Research, found that exposing 5-day-old rhesus monkeys to 24 hours of anesthesia resulted in poorer performance on tests of memory, attention and learning.
Dr. Randall Flick, associate professor of anesthesiology and pediatrics at the Mayo Clinic comments:
“You don’t have to be a rocket scientist to say, ‘Geez, if this happens in monkeys, then there’s a high probability that something like this occurs in humans.'”
In one 2003 study, scientists found that a combination of three anesthetic drugs given to seven-day-old rats resulted in brain-cell death at a critical time in brain development. And rats that received the medications had persistent learning and memory problems. That study and others got the attention of pediatric anesthesiologists and neurologists and prompted the Food and Drug Administration (FDA) to organize a meeting in 2007 to discuss the research.
At that time, FDA scientists stressed that there was no evidence that anesthesia caused problems in children, but they called on the anesthesia community to continue to study the medications. In a special report published last year, FDA researchers said anesthesiologists should “attempt to minimize exposure to potentially offending drugs when possible, to consider alternative therapies as may be available, and to remain vigilant as new information is developed.”
To galvanize research, the F.D.A. has formed a public-private partnership with the International Anesthesia Research Society.
Dr. Nancy Glass, a pediatric anesthesiologist at Texas Children’s Hospital and president-elect of the Society for Pediatric Anesthesia concludes:
“We’re all concerned. We don’t believe that there is data yet that says to us either that we should change our technique or that we should frighten parents about allowing us to anesthetize their children for necessary surgery.”
Source: The New England Journal of Medicine
Written by Sy Kraft, B.A.