A growing body of evidence suggests that the developing brain is uniquely vulnerable to anesthetic agents.
The developmental risk associated with exposure to general anesthesia in young children is largely unknown. In an editorial from the FDA published in the New England Journal of Medicine, the authors describe a growing body of evidence suggesting that the developing brain is uniquely vulnerable to anesthetic agents, particularly NmethylDaspartate (NMDA) receptor antagonists (e.g., ketamine) and aminobutyric acid (GABA) agonists (e.g., isoflurane). Studies in rodents and nonhuman primates indicate that prolonged exposure to these anesthetic agents during specific windows of neurodevelopment result in widespread neuronal cell death and long-term cognitive deficits.
Two retrospective cohort studies suggest that the risk associated with exposure to general anesthesia in animals also applies to children. In one study (J Neurosurg Anesthesiol 2009; 21:286), researchers compared 383 children who underwent inguinal hernia repair during the first 3 years of life with 5050 children who did not. Children who underwent surgery were twice as likely as controls to receive diagnoses of developmental or behavioral disorder. In the second study (Anesthesiology 2009; 110:796), investigators examined records of children exposed to one (449 children), two (100 children), or more than two anesthetics (44). The risk of learning disabilities increased with exposure to two or more anesthetics and with greater cumulative exposure to anesthesia.
Comment: Although the exact effects of early exposure to anesthesia in children are still unknown, the potential for an adverse effect on brain development is clear. Therefore, minimizing exposure to anesthetic agents is warranted. Reasonable options include delaying elective procedures until after age 3 years and using regional anesthesia when possible.
— Sandra Juul, MD, PhD
Sandra Juul, MD, PhD, is Professor of Pediatrics in the Division of Neonatology at the University of Washington School of Medicine in Seattle.
Published in Journal Watch Pediatrics and Adolescent Medicine May 4, 2011
Rappaport B et al. Defining safe use of anesthesia in children. N Engl J Med 2011 Apr 14; 364:1387.