18 March 2019. Many surgical procedures are painful, and general anesthesia is a frequent solution. However, this requires the use of vapors that induce temporary loss of sensation and attention, in fact the use of neurotoxic agents.
Experimental studies have shown immediate neuroanatomical and biochemical effects and longer-lasting functional delays or deficits in a variety of species ranging from roundworms to nonhuman primates. An ongoing concern is whether medical use of anesthesia has neurotoxic consequences, as has already been discussed here. As a result of the experimental studies, the U.S. Food and Drug Administration (FDA) issued a warning that general anesthesia and sedation drugs used in children less than 3 years of age or in pregnant women in their third trimester who were undergoing anesthesia for more than 3 hours or repeated use of anesthetics “may affect the development of children’s brains.” The FDA warning has been controversial, as resultant delays in necessary surgical and diagnostic procedures requiring anesthesia could lead to adverse outcomes for children and pregnant women. Clearly, physicians and parents must consider many factors when deciding whether a surgical procedure should be postponed or not. A new multi-site study has just been published. The study recruited infants mostly at 2-3 months of age who needed surgery for inguinal hernia. The infants, mostly males, were assigned to either awake-regional anesthesia or to general anesthesia (sevoflurane). At age 5 years, participating children were administered the full-scale Wechsler IQ test (Wechsler Preschool and Primary Scale of Intelligence, WPPSI-III). Results were available from 205 children in the regional anesthesia group and 242 in the general anesthesia group. Mean IQ scores were 99·08 and 98·97 in the two groups, thus suggesting no difference in the outcome. The duration of general anesthesia was slightly less than 1 hour. These findings suggest that the use of a common anesthetic for general anesthesia in early infancy does not affect neurodevelopment, at least not to an appreciable degree. Although these optimistic results should not be over-interpreted, so far it is good news. What remains to happen is for FDA and other regulatory agencies as well as the health care community to pay as much attention to all the non-medical brain drainers that continue to threaten children’s brain development.