General Anesthesia Linked to Language Problems in Children

missnurse01, MSN, RN · Dec 31, 2013

We had a presentation in grand rounds a few months ago from an anesthesiologist who does research out at the university in Charlottesville, Va. She gave all kinds of evidence of the same. It was rather horrifying what we put kids through without knowing (as I have had children with quite a few surgeries at young ages myself).

allnurses Guide · Dec 31, 2013

We had a presentation in grand rounds a few months ago from an anesthesiologist who does research out at the university in Charlottesville, Va. She gave all kinds of evidence of the same. It was rather horrifying what we put kids through without knowing (as I have had children with quite a few surgeries at young ages myself).

The problem right now is what other choice do we have. These children need surgery and we don't have an alternate method to anesthesia, yet. Hopefully, in the future we will find out the cause(s) of this and we can find an good alternate to reduce this problem.

missnurse01, MSN, RN · Jan 1, 2014

exactly. It's a necessary evil right now. The lady did talk about different techniques, trying to find a way to provide anesthesia without as much harmful effects. But it seems that all methods/routes do some damage. Hopefully the future will hold more promise.

babyNP., APRN · Jan 3, 2014

Yep, we had a lecture from an anesthesiologist and even GA for a stat c-section that only lasts a few minutes still has documented effects on the infant that is seen years later. Very scary...! I'm also a lot more choosy when deciding sedation needs for my infants in the NICU knowing that Midazolam may cause brain cell apoptosis...

I guess it's a balance, though, because if you don't have the GA for a stat section, you obviously are risking severe hypoxia and/or death depending on the reasoning for the stat section, so it's definitely better for a little exposure than that.

jwk · Jan 4, 2014

Read the article by the OP. The "evidence" is marginal at best and there have been NO prospective studies done. Considering the millions of children that have been anesthetized over the years, some of them who end up as physicians and nurses I'm sure, there is no conclusive evidence of causative effect at this point.

The idea that "all methods/routes do some damage" is an irresponsible statement not based on facts. Your alternative would be to use nothing - not exactly common sense, and nobody can say one way is better or worse than another based on current evidence.

There have been some better studies of cognitive dysfunction in elderly patients that seem to indicate they do worse with higher concentrations/durations of inhalational anesthetics, and some are using techniques with a BIS monitor to use the lowest possible concentration of agents and/or using more of a TIVA technique as an alternative. But all techniques have their limitations. One size does not fit all.

allnurses Guide · Jan 4, 2014

There are lots of studies/reviews done already? Anesthetics are causing learning disabilities. How much, who is susceptible, what types of anesthetics cause learning disabilities in children are the questions to be answered now not does it cause learning disabilities because that has already been determined.

Prenatal and Perinatal Anesthesia and the Long-Term Cognitive Sequelae: A Review.

Perna RB, Loughan AR, Le JA, Hertza J.

Appl Neuropsychol Child. 2013 Oct 24. [Epub ahead of print]

PMID: 24156239 [PubMed - as supplied by publisher]

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allnurses Guide · Jan 4, 2014

A review on BIS. Clinical effectiveness and cost-effect... [Health Technol Assess. 2013] - PubMed - NCBI

How can system that only measures one part of the brain be capable of helping determine responses in other types of the brain? The RAS responsible for awaking isn't even monitored by BIS which only monitors the frontal lobe.

jwk · Jan 4, 2014

Review articles and rat studies aren't exactly conclusive. No cause/effect relationship has been identified. If you can find a consensus document/study on exactly how to anesthetize children/neonates/pregnant women that require general anesthesia that guarantees no ill effects whatsoever, feel free to share. I'm not aware of any new standard-of-care techniques for anesthetizing these patient populations.

Does general anesthesia do funky things to the brain? Absolutely. Does it have any long lasting effect? I don't think that question has been adequately answered yet, although it appears the answer may be yes, but we have zero idea of how to quantify or measure that risk nor alternatives to use. But to potentially scare people out of anesthetizing pediatric patients based on the limited evidence available is absurd. Kinda like Jenny McCarthy scaring people out of vaccinating their children because of the risk of autism - which doesn't exist - and "oh, by the way, my kid doesn't have autism after all...my bad".

missnurse01, MSN, RN · Jan 5, 2014

Here is the name of the researcher that came to speak to us, and also her current research in this area. She is also on the SmartTots website. The site also lists her published research in this field.

My point was I feel that every drug we use has some sort of impact on the body, logically it must to have its desired effect. We do not know enough about this area, nor do we have a wonderful anesthetic mix we could use to mitigate all possible harmful effects. Hopefully the future will unveil the dangers, and show us new drugs we could use that would be safest.

Vesna Jevtovic-Todorovic, M.D., Ph.D., MBA

Broadly, my research interests focus on mechanisms by which anesthetic drugsinteract with neurotransmitter systems in the central nervous system to produceboth pharmacological and toxicological effects.

My primary interests thus far have centered on the identification andcharacterization of neurotoxic properties of commonly used intravenous andinhalational anesthetics with special emphasis on NMDA antagonist class ofgeneral anesthetics. It has extended to include several studies that have lookedat the pharmacological ways of protection against this type of neurotoxicity. Thisresearch is federally funded by NIA/NIH.

Another important aspect of my research is focused on pathophysiology andpharmacology of the neuropathic pain using whole animal models and a varietyof neurobehavioral tests.

2009-2012 Recovery Act Grant: “Anesthesia-induced developmental neuroapoptosis.” NIH/NICHD.

Principal Investigator: Vesna Jevtovic-Todorovic

2010-2012 R21 DA029342: “Validation of voltage-dependent T-channel blockers in treatment of neuropathic pain.”

Principal Investigators: Vesna Jevtovic-Todorovic and SlobodanM. Todorovic

2011-2014 R01: “Anesthesia-induced developmental neurodegeneration.”NIH/NICHD.

Principal Investigator: Vesna Jevtovic-Todorovic

2011-2014 March of Dimes National Award: “Anesthesia-induced risks of cognitive impairment during early stages of development: mechanism and prevention.” Principal Investigator: Vesna Jevtovic-Todorovic

allnurses Guide · Jan 5, 2014

Review articles and rat studies aren't exactly conclusive. No cause/effect relationship has been identified. If you can find a consensus document/study on exactly how to anesthetize children/neonates/pregnant women that require general anesthesia that guarantees no ill effects whatsoever, feel free to share. I'm not aware of any new standard-of-care techniques for anesthetizing these patient populations.
Does general anesthesia do funky things to the brain? Absolutely. Does it have any long lasting effect? I don't think that question has been adequately answered yet, although it appears the answer may be yes, but we have zero idea of how to quantify or measure that risk nor alternatives to use. But to potentially scare people out of anesthetizing pediatric patients based on the limited evidence available is absurd. Kinda like Jenny McCarthy scaring people out of vaccinating their children because of the risk of autism - which doesn't exist - and "oh, by the way, my kid doesn't have autism after all...my bad".

I already pointed out there is no agreement on which anesthetic agent(s) has this effect or how many times being exposed to anesthesia it takes to cause learning problems. We do know that at some point some or all of anesthetic agents will cause learning problems in developing brains.

Yes, we should scare our patients. We do informed consents not what makes the parents feel better consents. I tell each one of my patients that they may die from anesthesia. I don't sugar coat it, but I try to quantify the risks into common, unusual, and rare. I don't talk to parents about these particular potential complications, but I tried to stay well versed in the literature that way when parents ask about it I can discuss it with them. You don't even do pre-ops do you?

This by the way is just meant as a discussion for anesthesia providers/students to go hmm that is interesting or maybe when I do that I notice more problems with wake ups etc. It isn't meant to copied and handed out to patients.

jwk · Jan 5, 2014

I already pointed out there is no agreement on which anesthetic agent(s) has this effect or how many times being exposed to anesthesia it takes to cause learning problems. We do know that at some point some or all of anesthetic agents will cause learning problems in developing brains.
Yes, we should scare our patients. We do informed consents not what makes the parents feel better consents. I tell each one of my patients that they may die from anesthesia. I don't sugar coat it, but I try to quantify the risks into common, unusual, and rare. I don't talk to parents about these particular potential complications, but I tried to stay well versed in the literature that way when parents ask about it I can discuss it with them. You don't even do pre-ops do you?
This by the way is just meant as a discussion for anesthesia providers/students to go hmm that is interesting or maybe when I do that I notice more problems with wake ups etc. It isn't meant to copied and handed out to patients.

So - we have...

...Yes, we should scare our patients...

...We do informed consents...

and then...

...I don't talk to parents about these particular potential complications.

Just a little inconsistency there, don't you think?

As I've pointed out, there is no consensus on modifying currently accepted techniques for pediatric anesthesia. At what point anesthesia becomes problematic is unknown, and there is no method of quantifying risk of anesthesia in pediatric populations with respect to affects of anesthesia on the brain.