Pedi Anesthesia and Neuroapoptosis

[k12balla]

While there has been some literature to support the affects of anesthesia on cognitive abilities in lab animals, I am not familiar with any controlled human studies. Here is a consensus statement from smart tots which essentially states you should avoid surgery unless necessary in kids, and that more than likely anesthetics do cause cell death/a slight decrease in IQ long term . http://smarttots.org/smarttots-releases-updated-consensus-statement/


Do any of you prefer one method over the other for pediatrics, and if so why? I.e: Tiva vs volatile vs only regional if possible.

Sent from my SM-G920T using SDN mobile app

---

Members don't see this ad.

 

[DrLight]

While there has been some literature to support the affects of anesthesia on cognitive abilities in lab animals, I am not familiar with any controlled human studies. Here is a consensus statement from smart tots which essentially states you should avoid surgery unless necessary in kids, and that more than likely anesthetics do cause cell death/a slight decrease in IQ long term . http://smarttots.org/smarttots-releases-updated-consensus-statement/


Do any of you prefer one method over the other for pediatrics, and if so why? I.e: Tiva vs volatile vs only regional if possible.

Sent from my SM-G920T using SDN mobile app

There haven't been any studies which have shown a difference between TIVA and volatile anesthetics in terms of neurological outcomes.
There have been studies which look at GA versus spinal only in babies in cases less than 1 hour and they had no difference in cognitive ability.
(posted on front page of SPA website)

This article in the Journal of Pediatrics "Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia"
is probably one of the latest studies which really scared everyone at my institution..."The present findings suggest that general anesthesia for a surgical procedure in early childhood may be associated with long-term diminution of language abilities and cognition, as well as regional volumetric alterations in brain structure."

From my personal discussions with my colleagues who are experts in this area of research, this study was very well done and had a very thorough battery of tests to measure cognitive ability after just 1 anesthetic and was also correlated with change in MRI of the brain.

There are many studies going on right now, they just need time to follow these kids and we will have more conclusive data shortly. I think the fact that anesthesia for children is only recommended for essential surgery is advice that will not change anytime soon.

 

[deleted162650]

I had a pyloromyotomy at 6wks old. It kills me to think how smart I coulda been.

 

[Random Anesthesiologist]

I had a pyloromyotomy at 6wks old. It kills me to think how smart I coulda been.

Makes me want to vomit.

 

[pgg]

Odd to think that the old school "neonates don't feel pain" curare-only approach might have been better than the modern humane approach with volatile agents.

 

[nimbus]

Odd to think that the old school "neonates don't feel pain" curare-only approach might have been better than the modern humane approach with volatile agents.

Don't think that can be assumed. Emotional and psychological trauma can be damaging to the developing brain too.

 

[GA8314]

So, where I trained the pediatric urologists shouldn't be fraudulently diagnosing "phimosis" so that they can do their "uber" circumcisions to make 6 mo old penises look "pretty" for mommy? (yes, I've heard some mothers describe it this way and that's pretty creepy in and of itself) Thus, subjecting the 6 mo old to both Caudal blockade and GA? Seems not.

 

[IlDestriero]

Urology really is the biggest offender with their completely elective procedures. Maybe some plastic stuff could wait as well. I've asked our urologists, and they acknowledge it is a concern, and keep booking circs.

 

[YGK]

What about BMTs ? do you guys think 5 min volatile agent can be harmful to the growing brain ?

 

[Ignatius J]

Urology really is the biggest offender with their completely elective procedures. Maybe some plastic stuff could wait as well. I've asked our urologists, and they acknowledge it is a concern, and keep booking circs.

You're going to have a hard time getting people to stop wanting to make money with their bread and butter procedures.

How come no one has said anything about pedi dental? We do a lot of that. Lots of picking at and scrubbing teeth that are going to fall out in the next decade anyways.

 

[pgg]

Don't think that can be assumed. Emotional and psychological trauma can be damaging to the developing brain too.

I'm not really assuming anything, except that not having any surgery/anesthesia is probably better than having some surgery/anesthesia. I'm just always interested in cases where the new way of doing things turns out to maybe not be as superior to the old way as we thought. I'm not actually suggesting we do surgery on kids without anesthesia.

What about BMTs ? do you guys think 5 min volatile agent can be harmful to the growing brain ?

Not as developmentally harmful as hearing loss.