Are there Neurological Effects of General Anesthesia on Children?
Dr. Joonyoung Ji is presenting new research that was published in the Lancet about the neurological effects of general anesthesia on young children and infants.
In 2009, a retrospective review study found that children treated under general anesthesia before their fourth birthday were more likely to have learning disabilities. The study raised a number of controversies due to the widespread use of general anesthesia in infants and young children and because the study methodology was considerably flawed.
The same group later published a second retrospective review in 2018 with a better study design and refuted their own earlier findings and results, finding no difference in outcomes.
In the spring of 2019, the primary results of the only prospective randomized clinical trial in this field was published in Lancet. This study incorporated multiple centers in multiple countries and represents a significant piece to the puzzle.
Slightly less than 1h of general anesthesia in early infancy does not alter neuro-developmental outcome at age 5 years compared with awake-regional anesthesia in a predominantly male study population.
- The randomised controlled trial provides strong evidence that 1h of exposure to a general anesthetic during early infancy does not cause measurable neuro-cognitive or behavioural deficits at age 5 years.
- Nearly half the general anesthetics in infancy are used for less than 1h duration, and this study should therefore allay some of the concerns generated by pre-clinical data and previous cohort studies.
- This trial does not address the possibility that longer or repeated anesthesia exposures in early childhood are detrimental.
- The trial was also conducted in a predominantly male population, and thus further research is needed to answer these questions in female children and those with multiple and prolonged exposures.
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- Wilder, R. T., Flick, R. P., Sprung, J., Katusic, S. K., Barbaresi, W. J., Mickelson, C., … Warner, D. O. (2009). Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology, 110(4), 796–804. doi:10.1097/01.anes.0000344728.34332.5d
- Warner, D. O., Zaccariello, M. J., Katusic, S. K., Schroeder, D. R., Hanson, A. C., Schulte, P. J., … Flick, R. P. (2018). Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study. Anesthesiology, 129(1), 89–105. doi:10.1097/ALN.0000000000002232
- Lena S. Sun, MD, Guohua Li, MD, DrPH, Tonya L. K. Miller, MD, Cynthia Salorio, PhD, Mary W. Byrne, PhD, MPH, David C. Bellinger, PhD, MSc, Caleb Ing, MD, MS, Raymond Park, MD, Jerilynn Radcliffe, PhD, Stephen R. Hays, MD, MS, Charles J. DiMaggio, PhD, Timothy J. Cooper, PsyD, Virginia Rauh, ScD, Lynne G. Maxwell, MD, Ahrim Youn, PhD, and Francis X. McGowan, MD. Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. JAMA. 2016 June 07; 315(21): 2312–2320. doi:10.1001/jama.2016.6967.
- Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. The Lancet, Vol 387 January 16, 2016
- Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. The Lancet, Vol 393 February 16, 2019