Does anesthesia affect my child’s brain?
If I had to pick the question that I’m asked most often, from parents, friends, and colleagues alike, it’s whether or not anesthesia affects developing brains.
Human brain development is extremely complex. Over the past couple of years, a few studies have followed kids after they’ve received anesthesia, rather than just looking at old records to determine a correlation. The PANDA study compared siblings, one child who had a single exposure to anesthesia before the age of 3, while the other sibling was never exposed. In that study, the researchers found no differences in either IQ or other neurocognitive outcomes between the children on follow-up examination. Another study, the GAS study, randomized infants to receive general anesthesia versus awake spinal anesthesia for their hernia repair. In that study, the researchers found no detectable neurodevelopmental differences by 2 years of age whether the infants received general anesthesia or not! A follow up study reexamining those same children a few years later was still unable to detect any detrimental effects or differences between the two groups.
Currently, there is no expert consensus or definitive answer regarding the safety of anesthesia in children. Most of the evidence in human studies that suggests anesthesia may cause problems in children is retrospective in nature, and typically involves multiple exposures before the age of 3. For those children, it can be hard to determine if the neurocognitive decline is from exposure to anesthesia, the perioperative stress of surgery, or the patient’s underlying illnesses. What prospective data we do have seems to suggest that a single, relatively short exposure before the age of 3 is probably benign.
With everything we do, we must always weigh risk versus benefit. The decision to proceed with surgery is a personal one that only you can make. If any comfort can be found, take comfort in the fact that so far no irrefutable link between anesthesia and learning disabilities in children has been found, despite nearly two decades and countless research studies. Also, while many anesthetic drugs have been implicated, at least one drug may actually be neuroprotective. Furthermore, there is some data that enrichment activities may offset any potential damage exposure to anesthesia may cause, so if you needed another reason to read to your children tonight, there it is.
And remember, correlation does not always mean causation.
For a much more nuanced and thorough evaluation of the possible effects of anesthesia on the developing brain, I refer you to this article.
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