General Anaesthesia - Possible effects on Children’s brain development

Frequently Asked Questions for Parents:

What are the known possible effects of General Anaesthesia on children?

For the past 15 years, researchers have conducted studies to investigate the effects of anaesthetics on the nervous systems of developing animals. The results of these research studies show that exposure to some anaesthetics and sedatives leads to memory and learning difficulties and other harmful changes in the brains of some laboratory animals. Studies in humans have been less clear. Currently, there is not enough data to prove or disprove whether similar effects occur in children. Some studies have suggested that there may be adverse effects on behaviour, learning and memory when children under 4 years of age have prolonged or repeated exposures to anaesthesia and surgery. Other studies showed that a single anaesthetic for short procedures is not associated with these adverse effects. To date, there is no direct evidence that anaesthetics are unsafe for children but more research is needed. More information on study results can be found on the SmartTots* website - Smarttots.org/resources.*

_{SmartTots is a Public-Private Partnership (PPP) between the US Food and Drug Administration (FDA) and the International Anaesthesia Research Scoiety (IARS).}

If anaesthetics cause effects in animals, will they cause similar effects in people?

Although research in animals is often very helpful, it may sometimes cause undue concern. Animals are not human and changes in practice based only on laboratory animal studies may have unintended consequences that are not in the best interests of children. Much more research is needed to provide parents with additional information about the safe use of anaesthetic and sedative drugs in children. Until more information is available it is important that children continue to receive any necessary surgery and anaesthesia.

Is it harmful for infants and young children to undergo anaesthesia?

There is no direct evidence that anaesthetics are unsafe for children. The early research in animals has raised concerns about some anaesthetic drugs that need to be investigated further to determine if there is a risk to infants and children younger than four years of age. Newer studies have shown that short exposures to general anaesthetics in otherwise healthy children do appear to be safe. Current research is limited and is not yet conclusive, hence, dangers to infants and children from anaesthesia are unproven at this point.

What are the most common conditions requiring surgery for young children?

The most common procedures required for young children include ear tubes for chronic ear infection, tonsillectomy and hernia repair.

Are there alternatives to general anaesthesia for surgery in young children?

For most surgical procedures there are no realistic alternatives to the medications used for general anaesthesia. You should discuss this with your child’s anaesthetist, surgeon or health care providers.

Is one anaesthetic or sedative better or worse?

All commonly used sedatives and anaesthetics have been involved in animal studies. No single anaesthetic agent or technique has been proven to be better or worse than others.

What should I do if my child needs surgery or a procedure requiring anaesthesia or sedation?

Parents and caregivers should discuss the risks, benefits, and timing of surgery and procedures requiring anaesthetics and sedative drugs with your child’s healthcare providers.

For most surgical procedures, there are currently no realistic alternatives to the medications used for general anaesthesia. Untreated pain is known to be harmful in children and to the developing nervous system, and must be avoided.For non-painful procedures, it may be worthwhile to explore alternatives to anaesthesia or sedation.

Should I consider putting off a needed procedure until my child is older?

Children are not generally scheduled for surgical procedures that require anaesthesia unless the surgery is essential to their health. Therefore, postponing a necessary procedure may itself cause problems and would not be an option for the majority of children. For example, children with chronic ear infections may have delays in the development of speech related to problems with hearing. Surgery to treat this problem may improve learning whereas a delay may result in long-term difficulties in the normal development of speech. You should discuss the risks and benefits of the procedure and anaesthesia with your child’s anaesthetist, surgeon or healthcare provider.

Where can I learn more?

Plenty of resources can be found at Smarttots.org, including information about the latest research studies, newsletter articles and scientific presentations. You may also sign up to receive updates on the latest research at Smarttots.org/resources.