Research strongly links anesthesia to brain deficits in children. According to a Pediatric Anesthesia Neurotoxicity Panel, led by Dr. Vesna Jevtovic-Todorovic, M.D., Ph.D., M.B.A., Professor of Anesthesiology and Neuroscience at the University of Virginia Health System, infants and children who undergo procedures requiring anesthesia could experience learning disabilities, memory problems, ADHD and cognitive difficulties.
Animal studies have raised major concerns about anesthetics like ketamine given to infants and children that could affect the developing brain. Studies performed on rhesus monkeys, whose brains are similar to humans, strongly link anesthesia exposure to functional difficulties.
Merle Paule, Ph.D., Director of the Division of Neurotoxicology at the National Center for Toxicological Research and SmartTots Scientific Advisory Board member, says the studies raise serious concerns about repeatedly exposing children to anesthesia.
In primate studies, one exposure to ketamine, a type of anesthetic often used in children in the emergency room and for minor procedures, led to long-lasting deficits in animal brains.
The effects of anesthesia on human infants and children could be long-lasting, raising major concerns about multiple exposures to anesthesia before age 2.
Randall Flick, M.D., M.P.H., Associate Professor of Anesthesiology and Pediatrics at the Mayo Clinic said, "Very clearly, the studies done by the folks at the National Center for Toxicological Research are extremely important. They can't be overrated because they show in a species similar to humans that there is an effect not only on the pathology in the brain, but also in behavior.”
The findings were presented during the SmartTots: Pediatric Anesthesia Neurotoxicity panel at the International Anesthesia Research Society annual meeting in Vancouver, B.C.
Dr. Flick also discussed Mayo Clinic research at the meeting which concluded multiple episodes of anesthesia exposure before age 2 is a “significant” risk factor for Attention Deficit Hyperactivity Disorder, even after adjusting for illness that might contribute to cognitive function difficulties in children.
He notes, one exposure to anesthesia did not seem to increase the chances of ADHD or learning disabilities. However, age of exposure and number of anesthetics an infant or child is exposed to seemed to be “crucial”.
Children undergoing anesthesia before age 4, longer than 120 minutes, seem to have twice the risk of developing Attention Deficit Hyperactivity Disorder.
Anesthesia effects on young brains may be reversible
The good news, say the researchers, is multiple exposures to anesthetics that can lead to learning disabilities and ADHD later in life are reversible.
The effect of an inhaled general anesthetic agent, sevoflurane was reversible in rats. Scientists used environmental enrichment within 3 weeks of exposure to the drug.
The finding was discussed at the meeting by Greg Stratmann, M.D., Ph.D., Associate Professor of Clinical Anesthesia and Perioperative Care at the University of California, San Francisco.
According to Stratmann, “These findings support the concept that harnessing the brain’s natural ability to adapt to functional demands can modify the course of anesthesia-induced cognitive decline in rats.”
Studies pose dilemma for parents, physicians
The studies pose dilemmas for parents and physicians concerned about the effect of anesthesia on infants and children who need surgery that requires anesthesia but can have a detrimental effect on the developing brain.
Dr. Jevtovic-Todorovic suggests deferring surgery until a child reaches age 4 whenever possible. However, Dr. Flick says, for many, waiting is not an option and could cause even greater harm.
“We should not be tempted to change clinical practice unless we are certain that we need to and know exactly how to,” said Stratmann.
More studies are needed to understand how anesthesia exposure, especially before age 4, causes cognitive dysfunction and ADHD.
Jevtovic-Todorovic says it’s important for physicians to minimize the number of surgeries performed on infants and children and limit the amount of time children are sedated.
Funding for anesthesia research
Dr. Mike Roizen, M.D., Chairman of the SmartTots Executive Board, Chief Wellness Officer at the Cleveland Clinic, and co-author of the “YOU” series of bestsellers pledged $50,000 in annual support for research efforts.
During the meeting, the International Anesthesia Research Society (IARS) announced a contribution of $200,000 to launch the SmartTots fundraising campaign.
The pledge from Dr. Roizen and contribution from the IARS will help infants and children who require multiple surgeries that carry risks of learning disabilities and ADHD from multiple exposures to the drugs used during surgery.
The combined findings, according to the researchers, points to an “urgent” need for anesthesia guidelines, more research, and for ensuring the safety of new anesthetic agents through new models – something the SmartTots organization says would cost an estimated $40 million.
Dr. Roizen’s advice for parents, is to proceed with needed surgery and postpone surgical procedures that are unnecessary. Until more studies are performed, there is not sufficient evidence to fully define the risks of anesthesia for children that could lead to memory and learning deficits and other harmful changes in the brain. Postponing surgery could lead to more harm.
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