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General Anesthesia Tied to Developmental Woes in Kids
Date:10/21/2008

But findings are preliminary, and no reason to keep children from needed surgery, experts say,,,,

TUESDAY, Oct. 21 (HealthDay News) -- Youngsters under the age of 3 who had hernia surgery showed almost twice the risk of behavioral or developmental problems later compared to kids who hadn't had surgery, a new study finds.

Researchers suspect that exposure to general anesthesia during these operations might have played a role in the jump in risk, according to lead author Charles DiMaggio, an assistant professor of clinical epidemiology at Columbia University College of Physicians and Surgeons' Mailman School of Public Health in New York City.

"There really is no hard evidence that there is any causal association between anesthesia and developmental outcomes in children, though research in rat models indicates that there may be some association between the types of anesthesia and neuronal [brain cell] level changes," said DiMaggio. "The early concern is, could these data be extrapolated to humans?"

DiMaggio was quick to point out that even though the current study found an association between anesthesia use and neurodevelopmental problems, these are just preliminary findings. "The jury is still out; actually, the jury hasn't even retired to deliberate," he said.

DiMaggio was to present the findings Tuesday at the American Society of Anesthesiologists annual meeting in Orlando, Fla.

The study included 625 children under the age of 3 who had surgery to repair a groin hernia. The operations were performed with the children under general anesthesia.

The researchers compared this group of children to 5,000 randomly selected, age-matched children. All of the study participants were covered by the New York State Medicaid program.

Thirty children (4.8 percent) of the children exposed to anesthesia and 75 (1.5 percent) of the control group kids were eventually diagnosed with a developmental or behavioral disorder.

After adjusting for birth weight, age, gender, race and medical care utilization, the researchers concluded that children exposed to anesthesia were almost twice as likely to have a behavioral or developmental problem.

"This is an important study, but there are a lot of confounding variables," said Dr. Peter Davis, anesthesiologist-in-chief at Children's Hospital of Pittsburgh. "What exactly are we talking about? Are these kids who wet the bed? Kids who don't do well in school? Kids with behavioral problems? And, are there factors the researchers couldn't sift out from a database? Did all of these kids get the same level of prenatal care? How has their socioeconomic status changed from year to year? Did they all get the same anesthesia agents? I'm not sure the complete story is quite here yet."

Davis said that serious risks from anesthesia are incredibly small for children, though the risk from anesthesia is greater in children than it is in adults.

Both experts felt that any potential risks of anesthesia are likely outweighed by the benefits of surgery, and agreed that the findings are certainly no reason for parents to avoid necessary surgeries for their children. Davis advised parents of children who need to undergo surgery to make sure their child is treated by a pediatric anesthesiologist.

Another study, presented at the same meeting, found that between one and two out of every 100 children receiving general anesthesia reported possible or probable awareness during surgery. The study, which was done by researchers at the University of Michigan Health System, found that 1.3 percent of children reported memories of their surgical procedures that the researchers felt indicated "possible" awareness during the surgery. Another 0.3 percent had specific enough memories that they were considered to have "probable" awareness during the procedure.

Many of these children reported being scared or hurting during the surgery. Interestingly, however, fewer children with possible or probable awareness would be upset about having to undergo surgery again than youngsters who had no memories of the surgery -- 10 percent versus 15 percent, according to the study.

More information

To learn more about children and anesthesia, visit the Nemours Foundation.



SOURCES: Charles DiMaggio, Ph.D., M.P.H., assistant professor, clinical epidemiology, Mailman School of Public Health, Columbia of Physicians and Surgeons, New York City; Peter Davis, M.D., anesthesiologist-in-chief, Children's Hospital of Pittsburgh; Oct. 21, 2008, presentation, American Society of Anesthesiologists annual meeting, Orlando, Fla.


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