This is one of those things that is awful to read but important to know if you are the parent of a toddler diagnosed with a rare but very treatable cancer that has required surgery, multiple scans just to diagnose, port placement, and now multiple scans to follow up (on top of chemotherapy). I'm not dealing with single exposure here...I'm dealing with something like 6 different times within 2 months...4 just last month.
My son required general anesthesia for surgery as a 8 month old in 1988, my husband has always insisted that he noticed a change in his personality immediately afterwards. I don't remember such a change but 10 years later my son required an IEP, OT and eventually extended times for written exams. While his IQ is in the superior range, not only are his handwritting and fine motor skills poor but so is his executive functioning.
Anesthesia 25X and my memory at age 61 is shot!
Eye Surgery 1
Tonsils 1
Hernia 2
Defibrillator 8
Stent 1
Knee Surgery 1
Endoscopy 3
Colonoscopy 2
RFA 2
Lumbar Epidural 3
Glaucoma Surgery 1
There is a huge need to educate parents (and doctors!) on this topic. And not all pediatric anesthesiologists have great people skills.
My six month old daughter was literally headed in for a second MRI in two months (5am, full prep, I'm crying my eyes out with anxiety) when the anesthesiologist, who hadn't voiced any concerns to the ordering surgeons beforehand, pulled us aside and told us she'd be brain damaged if we did it.
As you might imagine, this just about sent me over the edge as i sat in a wheelchair with my baby, headed to the procedure room, trying to work out whether to trust this dude who sprang this on us, or trust the surgeon and neuro who had ordered the test.
Thank heavens I could call a friend who's a nicu nurse at CHOP to ask as we rolled down the hallways. She advised me to do it. Right as we crossed the threshold.
I mean really. What kind of "people skills" has a pediatric doctor who doesn't express reservations to a fellow Doctor first, and rather dumps it on a family at the literal last minute, with no research to back it up? At a highly esteemed NYC hospital?
To this day I don't know if it was the right decision but she's smart as a whip.
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To me, this is important:
"There was no impact on full-scale I.Q. in single or multiple exposures,” Dr. Flick said. But when there were two or more anesthesia exposures, researchers found an association with problems in fine motor skills and processing speed. Also, parents in the multiple exposure group rated their children as having more difficulty with behavior, particularly around attention."
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Do you really think that research will convince the parents?
@Ed
I don't think that the point is to "convince the parents." It may be reassuring to some. It is a good area to be studied. I, myself, had major surgery at 6 weeks of age. I also worked as a pediatric nurse. When infants or small kids need surgery it is not usually optional (heart defect, blocked intestinal tract, born with organs outside the body, tumors). Some surgeries, such as hernia repairs as noted, may be done with a spinal, but many others cannot. General anesthesia is the only option. The other risks to the child including basic survival or long term disability will far outweigh any fears that the child may have some less severe deficits from the anesthesia itself.
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This is very scary. I hope they are doing research on developing better anesthetics for children. (Oh wait, our legislators probably cut funding for that.)
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What about anesthesia for multiple days. My son had a seizure and then was intubated for 3 days. Are there any studies on this?
That’s another subject entirely.
However, a seizure requiring intubation itself has a significant morbidity and mortality associated with it far in excess of any attributable issue with Anesthesia.
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@Andrew Thank you for this response - when you read an article like this the guilt impulse goes into high gear.
If an operation is necessary, then the individual should undergo it. If general anesthesia is required, then it should be used.
This study provides an estimate of the difference in the long term adverse effects between two types of anesthesia (spinal/regional vs general) for one type of surgical procedure, useful in counseling parents and in choosing the anesthetic method.
It DIDN’T compare these groups directly to a non operated group. The abstract notes that 20% of the non general anesthesia group (74) had a “protocol violation”, possibly meaning that some of them required general anesthesia. The patient’s allocated to general anesthesia in contrast, had only 2 “protocol violations”.
Unlike studies in groups of genetically identical rodents reared identically, clinical trials deal with individual humans who differ from each other. (Even human twins reared in the same household may have markedly different experiences.)
Failure to show a difference between groups doesn’t eliminate the possible existence of effects in subgroups of individuals with unidentified vulnerabilities.
Ideally, in the future, we will be able to predict risks for an individual relatively precisely and accurately by using data from other individuals “just like him/her”.
We don’t have that ability at this time.
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One challenging issue for parents here is how to somehow presage whether your child will need one or multiple surgeries during childhood. For most parents of relatively healthy children, this is impossible to predict. This is why it seems important to many parents to avoid general anesthesia when unwarranted (for general dentistry, for easier imaging, etc), in order to "save" any exposure to general anesthesia for when it is truly medically necessary and unavoidable.
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