General Anesthesia Linked to Language Problems in Children

allnurses Guide · Jan 7, 2014

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.

How often do you do preops again?

All you are basically stating is what everyone else has already pointed out.

jwk · Jan 7, 2014

How often do you do preops again?
All you are basically stating is what everyone else has already pointed out.

I do pre-ops on every patient I anesthetize. Don't you?

All I was pointing out was the inconsistency in your statement.

allnurses Guide · Jan 7, 2014

I do pre-ops on every patient I anesthetize. Don't you?All I was pointing out was the inconsistency in your statement.

So you re-pre op every patient that you anesthetize. When an MDA determines your plan of care I don't consider that pre-oping. Unless you are saying you do not follow TEFRA/ACT guidelines. I am just pointing out the inconsistencies in your statement.... I realize what I said originally. It may have been confusing to you, but again every anesthesia provider that pre-ops and does anesthesia for pediatric patients should be conversant in these studies not just blow them off because we don't know the exact anesthetic triggering agents yet.

msn10 · Jan 12, 2014

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.

I agree. I read the article as well, and what is not readily identified in many of theses types of articles is why the child is getting surgery. Most healthy children never need surgery. Sure there may be a broken bone here and there, but for the most part, sickly children are the ones receiving multiple surgeries. If we take into account why a child needs surgery, coupled with a host of other sociological and neurological factors that promote learning, then we can make better conclusions. The study reported in Anesthesiology was a causal study at best. If wanting to know the true effects, they should really be doing the OWL studies on children before and after surgeries for baseline comparison, not children who have had surgery and those who have not.

Take for example dental surgery for for multiple cavities. IMO, the majority of the time, these kids are not receiving proper nutritional and parental oversight. There is even a direct correlation between learning and dental carries:

"Dental caries, periodontal diseases,and other oral conditions, if left untreated, can lead to pain,infection, and loss of function. These undesirable outcomescan adversely affect learning, communication, nutrition, andother activities necessary for normal growth and development." (California Society of Pediatric Dentists)

If parent do not even have their children brush their teeth, then what other basic needs are unmet?

We should always be vigilant, but ALL drugs have some type of side effect, and that is why we always need to question the need for surgery as it is always a risk. I remember a time when I worked in X-ray we did CAT scans all the time not really understanding the radiation effect, now doctors almost never order them.

allnurses Guide · Jan 12, 2014

Then how do you explain the animal studies showing changes in developing brains when repeatedly exposed to anesthetic agents. This has moved past the point where it is conjecture. Our anesthetic agents are causing the problems at least on some scale with developing brains, but what isn't known is how much it is a causative factor and which anesthetic agents are the most likely to cause these problems.

msn10 · Jan 12, 2014

Then how do you explain the animal studies showing changes in developing brains when repeatedly exposed to anesthetic agents. This has moved past the point where it is conjecture. Our anesthetic agents are causing the problems at least on some scale with developing brains, but what isn't known is how much it is a causative factor and which anesthetic agents are the most likely to cause these problems.

That was and was not my point.

I am saying that in healthcare, we should try and look at other alternatives besides surgery. There will never be a perfect drug for everyone, and there will never be a perfect drug for even one person until we completely understand and can decipher the DNA of every human and how each drug interfaces with every other drug based on said DNA.

You said "repeatedly exposed" and that was my point. I think we need to get to the underlying issues and try and prevent surgeries. We will of course need them for certain issues, but we are focusing too much on bandaids and not prevention. Should we be studying anesthetic reactions and side-effects? Absolutely, but too many of the kids that come for surgery have doctors and parents that could have tried other interventions before surgery.

allnurses Guide · Jan 12, 2014

That was and was not my point.
I am saying that in healthcare, we should try and look at other alternatives besides surgery. There will never be a perfect drug for everyone, and there will never be a perfect drug for even one person until we completely understand and can decipher the DNA of every human and how each drug interfaces with every other drug based on said DNA.
You said "repeatedly exposed" and that was my point. I think we need to get to the underlying issues and try and prevent surgeries. We will of course need them for certain issues, but we are focusing too much on bandaids and not prevention. Should we be studying anesthetic reactions and side-effects? Absolutely, but too many of the kids that come for surgery have doctors and parents that could have tried other interventions before surgery.

You have never done anesthesia if I remember correctly, so tell me how you do PE tubes, dental rehab, cochlear implants/ear surgery, tonsillectomies (the most common kinds of pediatric surgeries) without general anesthesia. Even with dental rehab for dental caries/abscesses you would need to change the culture and the whole infrastructure for outlying villages in Alaska to make a difference in those cases here in Alaska where I do most of my pediatric anesthetics. It is great to talk about what we should do, but the reality is these anesthetics are causing problems in developing brains and in non-developing brains too. We need to figure out the causitive agents and the length of exposure it takes in different age groups that are causing these problems in order to set up guidelines and hopefully develop safer anesthetics. People are always going to need surgery and anesthesia. Trying to find ways to avoid anesthetics is a bandaid solution to the problem at hand. Right now, we do not even have a firm grasp on how are volatile anesthetics work at this point.

manusko · Jan 12, 2014

That was and was not my point. I am saying that in healthcare we should try and look at other alternatives besides surgery. There will never be a perfect drug for everyone, and there will never be a perfect drug for even one person until we completely understand and can decipher the DNA of every human and how each drug interfaces with every other drug based on said DNA. You said "repeatedly exposed" and that was my point. I think we need to get to the underlying issues and try and prevent surgeries. We will of course need them for certain issues, but we are focusing too much on bandaids and not prevention. Should we be studying anesthetic reactions and side-effects? Absolutely, but too many of the kids that come for surgery have doctors and parents that could have tried other interventions before surgery.[/quote']
The majority of my pedi cases is ear tubes and tonsils. All on very healthy children.

msn10 · Jan 13, 2014

You have never done anesthesia if I remember correctly,

And you have never done research, if I remember correctly. I don't mean the kind you do in school under the guidance of your professor, I mean the kind in which you have to canvass the ORSP office, complete all ethical classes and guidelines, write a grant/proposal, receive a million + dollars, implement your program or research, test your hypothesis and then evaluate and produce your results in a peer reviewed journal. The kind of work you are constantly quoting, but have not produced on your own. I have. However, I try and listen to all other disciplines when considering ideas for solutions. I also don't remember seeing too many CRNA's in our pharmacology labs at Abbott so saying only a CRNA can speak to this is ironic since CRNA's are providing anesthetics, not inventing them.

Back to my point. Trying to prevent unneeded surgeries is an important step. You said

Even with dental rehab for dental caries/abscesses you would need to change the culture and the whole infrastructure

That is my point, and of course it can be done. Can we completely change a culture? Probably not, but we are trying to educate and change what we can to produce a healthy population which should be the true goal of health care. My colleagues just finished a 5 year intervention to reduce teen pregnancies. They have reduced the pregnancies in our large city by 50%. So by extension that is a significant decrease in epidurals, spinals, and cesareans, not to mention surgeries in newborns who did not receive proper prenatal care.

We need to figure out the causitive agents and the length of exposure it takes in different age groups that are causing these problems in order to set up guidelines and hopefully develop safer anesthetics.

Absolutely, but we also need to avoid getting anesthetics in the first place. That is not a bandaid for the solution, it is a definite part of the solution. However, drug companies don't want us to decrease surgical procedures for obvious monetary reasons.

so tell me how you do PE tubes, dental rehab, cochlear implants/ear surgery, tonsillectomies (the most common kinds of pediatric surgeries) without general anesthesia. AND The majority of my pedi cases is ear tubes and tonsils. All on very healthy children.

My view of "healthy is different than yours." These surgeries are not done on healthy children, in fact, the guidelines state that children should have 7 or more infections in a year before a tonsillectomy is recommended. But I am not going to get into reasons why these surgeries have declined and why we shouldn't do them. I simply made a comment that less anesthesia is almost always the safe route.

WTBCRNA - I am not certain why you do not want to consider anybody else's opinion if it does not match exactly with yours. You have an special aversion to anyone who is not a CRNA as if CRNA's are the chosen ones and everyone else is merely in your shadow. However, that is not how healthcare works. Everyone's opinion matters, in fact, that is the way research is going. The government is looking to award grants for research based on inter professional programs and HRSA is requiring that programs going forward require multiple discipline input. Getting along with others and valuing them is part of the "silence Kills" study as well. We need to collaborate, not allientate.

I do not see how wanting to decrease surgical interventions is a bad thing.

allnurses Guide · Jan 13, 2014

And you have never done research, if I remember correctly. I don't mean the kind you do in school under the guidance of your professor, I mean the kind in which you have to canvass the ORSP office, complete all ethical classes and guidelines, write a grant/proposal, receive a million + dollars, implement your program or research, test your hypothesis and then evaluate and produce your results in a peer reviewed journal. The kind of work you are constantly quoting, but have not produced on your own. I have. However, I try and listen to all other disciplines when considering ideas for solutions. I also don't remember seeing too many CRNA's in our pharmacology labs at Abbott so saying only a CRNA can speak to this is ironic since CRNA's are providing anesthetics, not inventing them.
Back to my point. Trying to prevent unneeded surgeries is an important step. You said
That is my point, and of course it can be done. Can we completely change a culture? Probably not, but we are trying to educate and change what we can to produce a healthy population which should be the true goal of health care. My colleagues just finished a 5 year intervention to reduce teen pregnancies. They have reduced the pregnancies in our large city by 50%. So by extension that is a significant decrease in epidurals, spinals, and cesareans, not to mention surgeries in newborns who did not receive proper prenatal care.
Absolutely, but we also need to avoid getting anesthetics in the first place. That is not a bandaid for the solution, it is a definite part of the solution. However, drug companies don't want us to decrease surgical procedures for obvious monetary reasons.
My view of "healthy is different than yours." These surgeries are not done on healthy children, in fact, the guidelines state that children should have 7 or more infections in a year before a tonsillectomy is recommended. But I am not going to get into reasons why these surgeries have declined and why we shouldn't do them. I simply made a comment that less anesthesia is almost always the safe route.
WTBCRNA - I am not certain why you do not want to consider anybody else's opinion if it does not match exactly with yours. You have an special aversion to anyone who is not a CRNA as if CRNA's are the chosen ones and everyone else is merely in your shadow. However, that is not how healthcare works. Everyone's opinion matters, in fact, that is the way research is going. The government is looking to award grants for research based on inter professional programs and HRSA is requiring that programs going forward require multiple discipline input. Getting along with others and valuing them is part of the "silence Kills" study as well. We need to collaborate, not allientate.
I do not see how wanting to decrease surgical interventions is a bad thing.

1. No, I haven't produced any original research, but that isn't the purpose of having a clinical doctorate. A clinical doctorate, in my case a DNAP, is to prepare someone to be an expert in the utilization of research as it pertains to your area expertise i.e. anesthesia.

2. Wow, you have produced research in this topic area! I am impressed please quote your articles on the cognitive effects of anesthetic agents so we can review them. I would love to read all of those articles. Otherwise, your whole point of I produced research and you have not was what?

3. CRNAs do all sorts of research and just because you do not know CRNAs doing research does not mean anything. I know CRNAs with PhDs in nursing (with focuses in cognition, MH, PTSD, PONV, Pain etc.), neuroscience, biochemistry, pharmacology, and education. These are all published CRNAs with original research. Almost all of them continue to do research in their respective areas of interest in anesthesia.

4. The average toddler will get 6-8 colds per year. Colds in children It isn't hard to see how one could get strep that many times a year. These children are still labeled as ASA/PS 1 unless they are still actively having URI symptoms or recently got over cold/URI if they are otherwise healthy. An anesthesia provider would know this. My definition of healthy is consistent ASA and AANA teaching on ASA/PS categories. The other main diagnosis to get a tonsillectomy is OSA and excising hypertrophic tonsils will sometimes eliminate the OSA.

5. That decrease of teen pregnancies still would not decrease the percentages of pregnant women getting C-sections or epidurals etc. It probably doesn't decrease the percentage of complications either or the need for more research into the areas of decreasing overall c-section rates or the need to develop better local anesthetics. I have my doubts that a large city would have decrease of 50% in teen pregnancies d/t set of interventions over a five year period, and if you reference a study at least post the link.

6. It is a bandaid solution. This isn't white tower school nursing. There are always going to be children and adults that are going to need anesthesia and not knowing how much exposure to anesthesia is "safe" before causing potentially permanent problems on developing brains is a real issue. Even in countries where surgical interventions are not as readily utilized this is still going to be an issue, so you can debate the need to decrease surgical/anesthetic interventions all day long but it still won't change anything about this issue.

7. I do enjoy working with other professionals, but you have a way of degrading CRNAs in just about every post on here. Whether it is from you trying sale everyone on the greatness of ACT practices by trying to make everyone believe they would be safer working with anesthesiologists or trying to make everyone believe that CRNAs do not make significant contributions to research. In this particular instance you have downplayed the significance of these studies and came up with a "bandaid" solution of trying to decrease surgeries in children in the U.S.. Trying to decrease anesthesia in children is great if you can do it, but it also shows a lack of understanding of this problem or the complexities of this issue that I come to expect from someone outside of anesthesia/surgery.

nomadcrna, DNP, CRNA, NP · Jan 13, 2014

WTB is 100% correct.

You need to "walk the walk" otherwise you just do not understand.

msn10 · Jan 13, 2014

Wow, you have produced research in this topic area! I am impressed please quote your articles on the cognitive effects of anesthetic agents so we can review them. I would love to read all of those articles. Otherwise, your whole point of I produced research and you have not was what?

I didn't say it was in that specific area, but I do research. I was trying to say that I disagreed with the process of the study. It should have been a before and after, not a comparative study to fully reveal the effects of said anesthetics.

CRNAs do all sorts of research and just because you do not know CRNAs doing research does not mean anything. I know CRNAs with PhDs in nursing (with focuses in cognition, MH, PTSD, PONV, Pain etc.), neuroscience, biochemistry, pharmacology, and education. These are all published CRNAs with original research. Almost all of them continue to do research in their respective areas of interest in anesthesia.

You are talking about 2 different things. CRNA's (or very few of them) have ever created pharmaceuticals. However, the difference is that I the ones I know in research (and yes I do know some very well), I respect and work with well.

That decrease of teen pregnancies still would not decrease the percentages of pregnant women getting C-sections or epidurals etc. It probably doesn't decrease the percentage of complications either or the need for more research into the areas of decreasing overall c-section rates or the need to develop better local anesthetics. I have my doubts that a large city would have decrease of 50% in teen pregnancies d/t set of interventions over a five year period, and if you reference a study at least post the link.

Teen pregnancy | IRP Poverty Dispatch

2nd paragraph - honored by the White House. And I didn't say it decrease the percentage, it decreased the raw number. But I do stand corrected, it was 47% decrease in 5 years, 50% decrease in 7 years.

I do enjoy working with other professionals, but you have a way of degrading CRNAs in just about every post on here. Whether it is from you trying sale everyone on the greatness of ACT practices by trying to make everyone believe they would be safer working with anesthesiologists or trying to make everyone believe that CRNAs do not make significant contributions to research.

I have never said that I do not value CRNA's, but rather I value CRNA's and MD's at the same time. You saying that I degrade CRNA's on every post is not only completely ridiculous, but it is the pot calling the kettle black. When someone gets a DNAP, they also very often teach. I cannot imagine learning from someone who is so quick to condemn and make fun of others. Instead of at least trying to see other points of view, you look for the item in a discussion and pounce. You love winning an argument, that is clear, but I have tried many times to talk with you. If I have ever made you feel like I was disrespectful to you or any other CRNA, it was not my intention, but after reading your replies to any of us who are not CRNA's, it seems as if you strive to belittle. My entire point about my research was to point out that I can read a research article, regardless of the type of medicine, and understand the rigor, the process, and if it is really a article that shows significance. I live part-time in the world of t-tests, factorial design, and IRB's and the other half in the hospital. I am well respected by my peers (as I am sure you are too) as I actively conduct and implement research with the input of many disciplines. You clearly have no respect for anything I do or anyone else who respectfully questions your posts. However, I respect the amount of work you have put into you DNP, I respect the time it takes to become one, and I respect the work that you and many others in anesthesia do as well. But telling my that I "lack of understanding of this problem or the complexities of this issue that I come to expect from someone outside of anesthesia/surgery" is very disrespectful. Learning delays were not discovered by those in anesthesia, the idea came about from pediatricians, child psychologists , neurologists, and others who's interest in this topic was published back in the late 1900's and early 2000's. Anesthesia is only recently been involved in the conversation. Again, it is a collaborative discussion with multiple disciplines involved.