Wednesday, February 26, 2014

Does GA in kids cause brain changes?

It's crazy all the scaremongering that's out there. Very hard for reasonable voices to subdue all the fear...
"During normal CNS development, neurons are produced in excess and the elimination of supernumerary neurons is critical for achieving normal brain morphology, brain size, and viability of the organism. Importantly, as part of normal brain development, as much as 50%-70% of neurons and progenitor cells undergo physiological cell death and elimination by an inherent cell death program...No studies were identified describing structural brain abnormalities in children after anesthesia. However, a multitude of studies demonstrate behavioral and neurocognitive abnormalities after surgical anesthesia."
http://mobile.journals.lww.com/anesthesia-analgesia/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2008&issue=06000&article=00014
"Fetal exposure to general anaesthesia during Caesarean delivery did not increase the risk for developing a learning disability compared with vaginal delivery without anaesthesia."
"Wilder and colleagues59 examined the effects of postnatal anaesthesia before age 4 and found that learning disability (maths, language, or reading) was higher in those children with multiple anaesthesia exposure and surgery before age 4...[but] the retrospective cohort had exposure to anaesthesia from January 1976 to December 1982, a period during which the most commonly used anaesthetic agents were halothane and nitrous oxide."
"383 children who underwent inguinal hernia repair during the first 3 yr of life...developmental delay or behavioural problems, the authors found the exposed cohort to have a 2.3-fold (95% CI 1.3–4.1) increased risk for such diagnosis compared with the unexposed cohort.56 As with the Sprung and Wilder studies, a significant limitation of this study was the outcome ...was non-standardized ...In addition... Although hernia surgery is not known to be associated with any specific conditions that give rise to abnormal neurocognitive function, it is still possible that there was bias from confounding due to indications for surgery."
"more recent study from the Netherlands failed to show any effects of anaesthesia exposure on long-term neurocognitive function using the Young Netherlands Twin Registry.55"
http://m.bja.oxfordjournals.org/content/105/suppl_1/i61.long

"A well-designed comprehensive study to examine the effects of multiple episodes of surgery, anesthesia, and sedation seems to be many years away at best and, perhaps ultimately, impractical."
http://pediatrics.aappublications.org/content/early/2011/09/28/peds.2011-2489.full.pdf

Update: It took until Oct 2015 to come up with this statement: "Since the release of the last consensus statement, new animal research has continued to show short- and long-term learning deficits when general anesthetics are administered at an age comparable to a human under the age of 4. This growing evidence, combined with limited clinical results, has led the working group to call for more research to determine the safety of current anesthetics for young children, as well as whether there are drugs that might mitigate any harmful effects.
While the statement does not recommend putting off needed surgery or procedures requiring anesthetics or sedatives – or conducting needed treatments without pain medication – it does urge health care providers and parents to discuss the risks, benefits and timing of any treatment. In particular, it advises weighing the benefits of any elective procedure against a  potential risk. Experts also suggest exploring alternatives to anesthesia or sedation when pain management is not an issue – for example, with diagnostic tests."
http://smarttots.org/smarttots-releases-consensus-statement-regarding-anesthesia-safety-in-young-children/

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