Should I Be Worried About My Child Undergoing Anesthesia?

August 20, 2012

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A new study published this week in the journal Pediatrics found that anesthesia exposure at age 3 years or less can cause problems with language — both understanding and expressing words.

Many parents who hear about this study will immediately wonder what impact it may have on their own children and ask:

  • Should I be worried about having my young child undergo anesthesia for a surgical procedure?
  • What if my children need something like an MRI, where they are not having surgery, but have to be sedated to hold still for the test? Should I be concerned?

And for those asking these questions, here’s what you need to know:

This new study has major limitations that prevent any conclusions being made about any adverse effect of anesthesia. This study performed formal tests of intelligence, learning, movement and language skills. However, the original purpose of the study was to assess the effects of prenatal ultrasound exposure on later neurodevelopment. The study was not originally designed to test the effects of anesthesia and surgery, and so the researchers had to go back many years later and look at the responses to questionnaires answered by parents.

The first problem is that the authors did not have any access to any medical records; and so did not know the duration of the anesthesia and surgery, and which drugs were used for anesthesia, and what doses were given. Whether the child was exposed to anesthesia or not was based on the parents' report only.

Second, this kind of study, where young children exposed to anesthesia are compared to children not exposed to anesthesia, can still not tell us if anesthesia is the cause of any problems with language comprehension or expression. There may be medical or genetic conditions causing the patients to need the surgery itself that are the causes of any language problems — the study could not test for all of these. We also cannot tell if the surgery itself, or being in or around the hospital could be the cause of any differences. This kind of study can only determine associations, and point us in the direction of better prospective studies.

Also, surgery cannot be performed without anesthesia, and the health benefit of the surgery outweighs not having the surgery, and so practice cannot be changed on the basis of this study. In other words, not having the recommended surgery (and the anesthesia that has to be provided with it) will be worse than any possible effects of the anesthesia drugs. So ongoing hearing loss and ear infections are worse if myringotomy tubes are not placed; continued throat infections or sleep apnea are worse if tonsils are  not removed;  pain and risk for incarceration is worse if the hernia is not repaired, etc. The best type of study design is a prospective study, comparing children having surgery with different kinds of anesthetic techniques and drugs. There is only one of these types of study underway, with no results available for several years because we have to wait for young children to grow and develop so they can complete the neurodevelopmental testing.

So, our conclusion is that surgeons, anesthesiologists, pediatricians and parents should not change their views about having surgery and anesthesia at this point based on this study. Anesthesiologists always take into account the individual child, and design anesthesia techniques, drugs and doses that are just right for the particular surgery or other procedure. If a procedure needing anesthesia is recommended by the surgeon or other physician, parents should speak to their child's anesthesiologist about any concerns or questions they may have; but feel confident that the benefit of the recommended procedure outweighs any theoretical risk of long term effects of the anesthesia, which all experts agree have not been proven yet.

8/28 Update: See video on local ABC13: Local doctors speak out against latest pediatric study on effects of anesthesia on children.

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