Although the medical community has raised concerns about the safety of anesthesia on the developing brains of young children, new research presented at the ANESTHESIOLOGY® 2015 annual meeting, found brief exposure to general anesthesia during infancy did not impair neurological development. This is the first prospective, randomized, controlled clinical trial to assess the long-term, neurological effects of anesthesia in children.
"Our research provides the strongest evidence to date that anesthesia does not cause cognitive issues in infants undergoing general anesthesia and that brief exposure to anesthesia need not be avoided," said Andrew Davidson, M.D., lead author of the study and senior anesthetist, Department of Anesthesia, Royal Children's Hospital, Melbourne, Australia. "Our study, which covers two years of developmental outcomes, is the first to address the issue of neurotoxicity of general anesthetics in developing human infant brains."
Although exposure to anesthetics in developing brains has been linked to abnormalities in behavior, learning and memory in research conducted in animals, the effect in human children is unknown. Some studies have suggested that problems similar to those seen in animals could also occur in infants and toddlers. However, these observational studies have limitations that prevent experts from knowing whether these outcomes were due to the confounding effects of surgery, pathology or existing medical conditions.
In the study, researchers examined 700 infants, up to 60 weeks old, who were undergoing hernia repair in hospitals across seven countries. Half of the patients were randomly assigned to receive general anesthesia, while the other half received regional anesthesia and remained awake. The median duration of surgery in both groups was approximately one hour. The authors assessed the children's neurological development at 2 years of age. The authors found that children in both the general and regional anesthesia groups had similar cognitive scores.
"Some physician anesthesiologists, pediatricians and surgeons have started to delay procedures in some children until they are older due to previously existing data," said Dr. Davidson. "Although not definitive, our research provides strong clinical evidence that general anesthesia in infancy does not result in substantial neurotoxicity."
SmartTots, in partnership with the ASA, recently released a consensus statement on the "Use of Anesthetic and Sedative Drugs in Infants and Toddlers," which urges health care providers, patients and caregivers to discuss the timing of planned procedures and to evaluate each child's care individually based on age, type and urgency of the procedure and other health factors.
The findings of the current study were also published in the Lancet.