Single paediatric anesthesia entails no apparent cognitive risks

by Bruce Sylvester: A single exposure to general anesthesia does not lead to a cognitive risk in healthy children under age three, researchers reported On June 7, 2016 in JAMA/ Journal of the American Medical Association.

“A number of animal studies have suggested that exposure to commonly used anesthetic agents in early development could lead to deficits in learning, memory, attention, and other cognitive functions,” said lead investigator Lena Sun, MD, the Emanuel M. Papper professor of pediatrics at Columbia University Medical Center, and chief of pediatric anesthesiology at NewYork-Presbyterian/Morgan Stanley Children’s Hospital, both in New York, NY. “However, few clinical studies have adequately addressed whether this is also true in humans. Based on our findings, we can reassure parents that one exposure to anesthesia is safe for healthy young children,” she added.

Investigators from the Pediatric Anesthesia Neurodevelopment Assessment (PANDA) study studied whether exposure to one anesthetic of short duration (median of 80 minutes) in children under age three affected global cognitive function (IQ) 5-12 years later.

The researchers enrolled 105 healthy children who underwent surgical repair of inguinal hernia, a common childhood operation.

Then they assessed IQ scores and secondary neurodevelopmental outcomes, including memory, learning, processing speed, visuospatial function, attention, executive function, language, and behavior, when the subjects were between the ages of 8 and 15.

They compared scores for each subject to those of a healthy, biologically related sibling of a similar age who had not been exposed to anesthesia.

“There was no significant difference in IQ scores between the children who were exposed to anesthesia and siblings who were not,” said Sun. “We also saw no difference in most of the secondary outcomes, although more children in the group exposed to anesthesia exhibited internalizing behavior that required further clinical evaluation. That’s an area that needs to be further explored.”

Negative internalizing behaviors include anxiety, social withdrawal, and feelings of loneliness and guilt.

“The potential neurotoxicity of anesthetic agents commonly used in general anesthesia has been one of the most pressing concerns in pediatric surgery in the past decade. The PANDA project is among the most rigorously designed studies aimed at addressing this concern. Our findings should be reassuring to millions of parents whose young children need to undergo surgical procedures under general anesthesia across the world each year,” added co-author Guohua Li, DrPH, MD, professor of epidemiology at Columbia University’s Mailman School of Public Health and College of Physicians and Surgeons.