Authors: Chase Doyle
Anesthesiology News
The findings of a sibling-matched cohort study should reassure parents of young children that anesthesia for surgical procedures is safe at early ages.
According to a retrospective analysis of more than 10,000 sibling pairs, exposure to surgery and anesthesia before entry into primary school did not increase the risk for adverse developmental outcomes compared with biological siblings who did not undergo surgery.
“Based on this study and others, there is increasing evidence that most children who undergo surgery and anesthesia are not at increased risk of adverse child development outcomes,” said James D. O’Leary, MD, an associate professor of anesthesia at the University of Toronto and an anesthesiologist in the Division of Cardiac Anesthesia at the Hospital for Sick Children, also in Toronto. “However, most children in the current study who were exposed to general anesthetic drugs had a single surgery performed that typically did not require lengthy exposure to anesthesia.”
“Investigators have previously studied siblings of patients who have required general anesthesia to mitigate for these factors, but what has become evident from more recent population-based studies is that the magnitude of risk associated with pediatric anesthesia neurotoxicity represents only a small fraction of the variability seen,” Dr. O’Leary said. “As a result, large sample populations may be required to detect potentially small differences in child development outcomes.”
- physical health and well-being;
- social knowledge and competence;
- emotional health and maturity;
- language and cognitive development; and
- communication skills and general knowledge.
All eligible children in public and Catholic schools in Ontario, Canada, from 2004 through 2012, were included in the study, and data were analyzed from Dec. 13, 2017, through July 27, 2018. The research was published in JAMA Pediatrics (2018. doi: 10.1001/jamapediatrics.2018.3662. [Epub ahead of print]).
No Significant Developmental Differences
The study identified a total of 10,897 sibling pairs (21,794 children; 53.8% female; mean age, 5.7 years) from the 187,226 eligible children for whom the EDI was completed, and 2,346 sibling pairs had only one child exposed to surgery. Analysis of the data found no significant differences between exposed and unexposed children in early developmental vulnerability or for each of the five major EDI domains after adjusting for confounding factors (age at EDI completion, sex, mother’s age at birth and eldest sibling status).
Although the study should reassure parents of young children, Dr. O’Leary said, it is still not known whether children with repeated or lengthy exposures to surgery and anesthesia have an increased risk for adverse neurodevelopmental outcomes, and there may be subgroups of children with increased vulnerability to anesthesia-related neurologic injury.
“Recent ambidirectional cohort studies—PANDA and MASK—have added substantially to the evidence base investigating pediatric anesthesia neurotoxicity, but more definitive clinical studies providing high-quality evidence of a relationship between exposure to anesthesia and neurological injury are still required to guide treatment decisions for children undergoing surgery and anesthesia,” Dr. O’Leary said. PANDA is the Pediatric Anesthesia and Neurodevelopment Assessment and MASK is the Mayo Anesthesia Safety in Kids studies. “Parents of children requiring surgery should be cautioned about delaying necessary surgery and should consult an anesthesiologist or other qualified physician for advice about their child’s condition.”
In an interview, Cheryl K. Gooden, MD, an anesthesiologist at Yale New Haven Hospital, in Connecticut, who is a member of the editorial advisory board of Anesthesiology News, said this retrospective study provides anesthesiologists with another look into an area that still needs more clinical research.
“The results of the study demonstrated no evidence to suggest that early childhood exposure to anesthesia and surgery was linked to an increased risk of adverse child development outcomes,” Dr. Gooden said. “These findings provide further support to an earlier clinical trial, the PANDA study, that also investigated sibling pairs with only one of them exposed to anesthesia and surgery. No association was found.
“For now, the findings of this s tudy as well as in the PANDA study suggest that in early childhood, a single short exposure to anesthesia and surgery is not associated with an increased risk of adverse development outcomes,” Dr. Gooden concluded. “Indeed, more clinical research is needed in this area, particularly as it relates to longer exposure and multiple exposures to anesthesia and surgery.”
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