Nearly 20 organizations including the Academy have endorsed an updated “consensus statement” from the organization SmartTots calling for more research into the safety of anesthetics and sedatives administered to children younger than 4 years.
Some evidence has shown that such exposures in very young animals are associated with impairment in learning ability, behavior and memory. Human research, however, has been mixed, according to SmartTots, a partnership of the International Anesthesia Research Society and the Food and Drug Administration.
SmartTots (Strategies for Mitigating Anesthesia-Related neurotoxicity in Tots) is a multiyear collaborative effort to increase the safety of anesthetic and sedative drugs for the millions of children who undergo surgery or other procedures each year.
The statement emphasizes the need to discuss the timing of a child’s surgery or procedures. It does not recommend delaying needed surgery or procedures requiring anesthetics or sedatives, or conducting needed treatments without pain medication.
The AAP Surgical Advisory Panel, which is chaired by Dr. Houck, is convening a task force of surgical subspecialists to develop guidance around the optimal timing of certain surgical procedures.
“The hope is that we can help pediatricians better discuss the timing of surgery with parents,” Dr. Houck said.
The consensus statement was developed at a June meeting that brought together experts in anesthesia, pediatrics, neuroscience and patient safety. Additional medical organizations signed on to the updated statement, including the American Pediatric Surgical Association and the Pediatric Orthopedic Society of America.
After the June SmartTots meeting, a new study led by Andrew J. Davidson, M.D., was released at the annual meeting of the American Society of Anesthesiologists. The study found infants exposed to approximately one hour of general anesthesia did not have different cognitive outcomes at 2 years of age than infants who had the same surgery with regional anesthesia. It is the first randomized anesthesia trial investigating this topic.
“What they found was, for kids who were evaluated at 2 years of age after receiving general anesthesia or regional anesthesia for a hernia repair, there was no difference in any of the neurobehavioral outcomes they measured,” Dr. Houck said.
However, she pointed out that a hernia procedure is a short surgery; there were exclusions in terms of age range; and the study was preliminary and only evaluated children at 2 years.
“There might be differences looking at kids at 5 years,” she noted. “Even though this first randomized study did not show anything specific between the two groups, it still doesn’t really address the concerns about long term-effects for children who have received multiple anesthetics — which is the specific area of concern that previous studies have identified — and children who have had very prolonged anesthetics.
“To be honest, it makes us all feel a lot better about those little short procedures in infants that probably are not nearly as scary or concerning as we might have thought,” Dr. Houck said.
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