How risky is anesthesia for young children?

Growing concern about the effects of general anesthesia on brain development in infants and young children has prompted a call for more research and a warning to parents and physicians to take into account the potential risks when considering surgery for children aged younger than 3 years.

Writing in the New England Journal of Medicine, a group of experts in anesthesiology and toxicology urge large-scale clinical trials to help answer questions raised by mounting evidence from animal research that general anesthesia may have neurotoxic effects on the developing brain, leading to

later on.

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They cite a “heightened level of concern” over “compelling” data-initially in baby rats, then in monkeys-documenting brain damage and long-term behavioral abnormalities from anesthetics. A few observational studies in humans generally support the animal data, pointing to possible development of learning deficits in some children who underwent anesthesia at an early age. The limitations of these studies preclude drawing definitive conclusions about whether anesthesia or other variables such as surgical trauma, caused the adverse effects, however.

To address concerns about general anesthesia, the US Food and Drug Administration (FDA) partnered with the International Anesthesia Research Society in 2009 to found the nonprofit Strategies for Mitigating Anesthesia-Related Neurotoxicity in Tots (SmartTots). In 2012, the FDA, SmartTots, and the American Academy of Pediatrics issued a consensus statement that recommended avoiding elective surgeries using general anesthesia in children aged younger than 3 years and advocated more research into the risks of anesthesia.

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After reviewing subsequent accumulated animal and human research data, SmartTots posted a draft revision of the 2012 consensus statement in late 2014 recommending that “surgeries and procedures requiring anesthetic and sedative drugs that could reasonably be delayed should possibly be postponed because of the potential risk to the developing brain of infants, toddlers, and preschool children.” The revised statement recognizes, however, that “many surgeries and procedures in this age group are necessary and may require the use of anesthetics and sedatives.”

The proposed revision also emphasizes the need for “definitive clinical trials” to determine whether anesthetics and sedatives cause brain damage and impair neurocognitive development in young children.

The authors of the New England Journal of Medicine article note that a combination of animal studies and clinical trials will need to answer questions such as whether certain children are more vulnerable to adverse effects of anesthesia, whether damage is dose-related, whether underlying conditions increase the risk of harm, and whether strategies can be devised to reduce brain injury.