Will my child become less intelligent after anaesthesia?
Will anaesthesia have any effect on my child’s brain?
These are a couple of the burning questions most parents will ask me about anaesthesia for their child’s surgery.
As you can tell, their main concern is the effects of anaesthetic drugs on their child’s brain development and function.
They are worried about any unwanted side effects that may occur later in their child’s life.
Two decades ago, clinical trials in rats showed the possibility of anaesthetic drugs harming the developing brain.
This led to serious concern about the administration of anaesthetic drugs in babies and children.
In 2016, the US Food and Drug Administration (FDA) issued a black box warning – the most stringent level of warning – on the packaging of general anaesthetic and sedation drugs.
The warning noted that when such drugs are used repeatedly or for prolonged periods of time during surgery or procedures in children younger than three or in pregnant women during their third trimester, it may affect the development of the child’s brain.
This warning has drawn much criticism from healthcare professionals as it was based on inconclusive studies with no properly-linked evidence to humans.
Anaesthesia and sedation may be necessary for babies and children who require surgery or other painful and stressful procedures, especially when they face life-threatening conditions.
Indeed, three studies – the MASK, Panda and GAS studies – have provided clinical evidence that supports the safety of anaesthesia with regards to the developing brains of children.
The MASK (Mayo Anesthesia Safety in Kids) study was conducted from 1994 to 2007 in Minnesota, United States, to look at the effects of single or repeated exposure to anaesthesia on the participants’ brain development and intelligence.
This was a retrospective study, with the participants being children who had anaesthesia before age of three.
These children subsequently underwent neuropsychological testing when they were between eight to 12 years old, or 15 to 20 years old.
The results found that anaesthesia exposure before the age of three was not associated with deficits in general intelligence.
The Panda (Pediatric Anesthesia and Neurodevelopment Assessment) study examined whether exposure to a single anaesthetic of short duration (an average of 80 minutes) in children under the age of three had an effect on cognitive function (IQ) later in life.
This study included 105 healthy children who underwent inguinal hernia repair – one of the most common operations in early childhood.
IQ scores and other secondary neurodevelopment outcomes such as memory, learning and behaviour, were assessed when the children were between the ages of eight and 15.
The results for each child was compared to that of a healthy, biologically-related sibling of similar age who was not exposed to anaesthesia.
The study found that there was no significant difference in terms of IQ scores and other neurodevelopmental outcomes between the children who were exposed to anaesthesia and their siblings who weren’t.
Meanwhile, the GAS (General Anaesthesia Spinal) study was a randomised controlled trial conducted at multiple sites between 2007 and 2013.
Its aim was to investigate the long-term effects of two commonly-used modes of anaesthesia – general anaesthesia and spinal anaesthesia – and to determine whether they result in any adverse neurodevelopment outcomes.
A total of 722 newborn babies undergoing hernia surgery were randomly assigned to receive either general or spinal anaesthesia that lasted less than an hour.
The children then underwent developmental testing at the age of two, and neurodevelopment and intelligence testing at the age of five, to determine whether there are any differences between the two groups.
It was found that there was no significant difference between both groups regarding cognitive function at ages of two and five.
This study provides strong evidence that anaesthesia of less than an hour in duration does not damage the brain.
As can be seen, all these clinical trials provide strong evidence that short-term exposure to anaesthesia at a young age does not affect a child’s development in terms of intelligence, memory, learning and behaviour, among other neurodevelopmental outcomes.
In addition, childhood anaesthesia typically involves short procedures and likely carries low risk.
At present, there is no conclusive evidence or consensus that general anaesthesia harms the brain, whether in children or adults.
Advances in anaesthetic pharmacology and monitoring have allowed complicated surgeries to be conducted safely in children.
Parents are encouraged to discuss their concerns with the surgeons and anaesthetists regarding the risk and benefits of any procedure their child has to undergo.
Withholding general anaesthesia for a planned surgical procedure can lead to excessive pain and a stress response in the child, which can be detrimental for brain development.
Therefore, careful consideration is necessary for each individual patient.
Dr Sivaraj Chandran is a paediatric anaesthetist at Hospital Tengku Ampuan Afzan, Kuantan, Pahang. For more information, email firstname.lastname@example.org. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.