general anesthesia

A single hour of general anesthesia in early infancy longer than is necessary to perform the most common types of minor surgeries in childhood does not result in measurable underdevelopment or behavioral problems up to the age of 5 years, according to the first randomized trial of its kind involving 722 infants in seven countries, published in The Lancet.

Strongest evidence

The trial provides the strongest evidence to date that one brief exposure to anesthesia is safe in young children. Nevertheless; the authors caution that most (84%) study participants are male and more research is need to confirm the findings in girls and children with multiple and prolong exposure to anesthesia.

“Nearly half the general anesthetics given to infants are used for less than one hour, therefore our findings should reassure health professionals and the millions of parents whose young children undergo surgical or diagnostic procedures with anesthetic drugs worldwide every year,” says Professor Andrew Davidson, Murdoch Children’s Research Institute, Australia, who led the study.

Anesthetic techniques

“Parents and clinicians may want to delay necessary procedures particularly in very young children. These findings mean children no longer need to be subject to the potential medical and developmental risks of delaying surgery; and anesthetists do not have to avoid general anesthetics in favor of less  establish anesthetic techniques.”

The study is the first randomized trial to investigate whether exposure to general anesthesia in infancy , a time of high brain vulnerability; negatively impacts the growing brain at age 5. During the first 3 years of life; around 1 in 10 children in developed countries equating to millions of children every year undergo surgical; medical, and diagnostic procedures under general anesthesia including hernia repair; tonsillectomy, imaging, and endoscopes.

Anesthetic drugs

For over a decade, the potential neurotoxicity of commonly use anesthetic drugs in children is debat. In 2017; the US Food and Drug Administration warned that prolonged or repeated anesthesia in children younger than 3 years of age might affect brain development. However, this warning was based largely on animal studies which showed increased cell death in developing animals.
So far; research in humans are limit to observational studies that have report conflicting findings; and are unable to conclude whether anesthesia itself is causing problems; or if other factors such as the underlying medical conditions that make surgery necessary; or the surgical procedure itself, might be to blame.
The authors note several limitations, including that there are a substantial number of deviations from the treatment protocol in the awake-regional group because children had to be given general anesthesia; and a number of children are lost to follow up over the 5 years. They also point out that although several general anesthetics are commonly use in children, participants in the trial only received sevoflurane; which could limit the generalisability of the findings. Additionally; 5 years of age may be too young to detect some executive functions and social-emotional skills which do not develop until later in life.