Effects of General Anesthesia on Child Brain Development

Joyce F Henry BSN RNC PNP

Abstract General anesthesia/ Sedation Animal Study Results Evidence suggest that psychoactive drugs alter neurodevelopment and What is general Anesthesia / Sedation? Animal Study result synaptic plasticity in the animal brain, which, in the human brain, may translate • General anaesthesia or general anesthesia is a medically induced coma with Rodent studies – An initial study on anesthetic neurotoxicity reported that to permanent neurodevelopmental changes associated with long-term loss of protective reflexes, resulting from the administration of one or more exposure of immature rodents to a combination of commonly used anesthetic intellectual disability. In humans, there is growing evidence that suggests general anaesthetic agents. agents (ie, midazolam, nitrous oxide, and isoflurane) resulted in deletion of anesthetics have the potential to harm the developing brain, but the long-term • Sedation, on its own, is the depression of awareness, whereby a patient neurons, defects in synaptic function in the hippocampus, and cognitive outcome is not definitive and causality has not been determined. The response to external stimuli becomes limited. Sedation may be minimal, impairment as juveniles and young adults [19]. Subsequent studies have consensus is that there is more work to be done using both animal models and moderate or deep. corroborated these findings in both mice and rats, using a variety of anesthetic human clinical studies. • The goal of the use of general anesthesia and sedation in the pediatric agents, durations of exposure, and a range of outcome measures [20 population is to help make children safe, comfortable, and not to experience pain during surgery, procedures and studies. • In one study, infant rhesus monkeys that were exposed to sevoflurane for four hours on days of life 6 to 10, followed by subsequent exposures on days Source Dean B Andropulos, “ Effect of Anesthesia on the Developing Brain of life 14 and 28, demonstrated increased anxiety compared with controls infant and Fetus. Fetal Diagnosis and Therapy June 7,2017 that underwent only a brief period of maternal separation [21]. Anxiety was measured with the human intruder task, a standardized tool that allows assessment of emotional reactivity. Item 122 233 345 • In another study, infant rhesus macaques that were exposed to isoflurane for five hours on days of life 6, 9, and 12 demonstrated motor reflex deficits at Item 759 856 290 one month of age and increased anxiety at 12 months of age [22]. Background Importantly, there were no significant effects of a single isoflurane exposure Item 228 134 238 in this cohort. In December 2016, the U.S Food and Drug Administration issued a drug safety Item 954 875 976 • Studies have reported neuronal apoptosis in the fetal and neonatal NHP announcement, warning that “repeated or lengthy use of general anesthetic and brain induced by prolonged exposure (5 to 24 hours) to isoflurane [23-25], sedation drugs during surgeries or procedures in children younger than 3 years ketamine. may effect the development or children’s brains. Item 324 325 301 • FDA said “lengthy” means more than 3 hours Item 199 137 186 • Repeated means 2 or more times • Source Richard Novak , MD “ Anesthetic Risk in Children’s . “ The • Some research studies on animals have shown that repeated or lengthy Anesthesia Consultant 2010 exposure to anesthesia and sedation can cause negative changes to the • Include additional information or methods here. animal brain and development • Some human studies have shown that giving anesthesia and sedation 1 t • Source: Brain Development julesdidlio.com

• Source Richard Novak, MD “ Anesthetic Risk in Children” The Anesthesia Consultant 2010

Objectives Human Study Results Results • Define what is general anesthesia/ sedation Human studies ease concerns There are health problems that can be potentially life threatening that may cause children under the age of 3 to require anesthesia ; • Assess the benefits and risk of general anesthesia on children brain • Fortunately, if exposure is limited and used in children who are older, several • Pyloric stenosis development according to animal studies studies support their safety. • Diaphragmatic hernia • Identify health problems where treatment and studies should not be delayed • Research of children who have had only one exposure to anesthesia • Congenital heart defects or avoided suggest that “anesthesia is very safe and that children’s long-term cognitive • Gastroschisis and omphalocele development is unaffected,” says Dr. Niezgoda. • Provider will be able to educate families on the risk and benefits of general • Esophageal atresia anesthesia on children under the age of 3 years • One large study of 2,500 ninth graders found no significant difference in There are other health problems in young children that may not be life threatening : educational outcomes between students exposed to a single anesthetic for hernia repair and age-matched students never exposed to an anesthetic. • Dental rehabilitation • Another study compared twins having a single anesthetic to twins never • MRI, CT scans,nuclear medicine exposed to an anesthetic and found no relationship between anesthesia and • Skin tag excision cognitive performance (learning ability). While these studies are encouraging In conclusion there is not enough evidence that provides evidence practice that with regard to the safety of anesthesia in children the data was retrospective anesthesia effects brain development in the young child. Recommendation is that the (looking at children who already had anesthesia). parent or caregiver need to be informed of the potential complication and discuss with their provider if the procedure can be delayed until the child is over 3 years of age. `