Anesthesia use in kids linked to learning disabilities
October 3rd, 2011
11:57 AM ET

Anesthesia use in kids linked to learning disabilities

When your kid needs surgery, your response is probably, “Do whatever is necessary to fix him NOW. We’ll worry about later, later.” But it turns out that putting a child under anesthesia may increase the risk of long-term damage to his or her ability to think.

A new study published by the American Academy of Pediatrics concludes that exposure to anesthesia before age 2 may manifest in a form of cognitive impairment called apoptotic neurodegeneration. But let’s not get ahead of ourselves. First of all, the researchers found no greater risk in those subjects who had only been “put under” once. Multiple exposures to surgery/anesthesia, on the other hand, significantly increased the risk of developing learning disabilities later on in life.

The estimated incidence of learning disabilities, as measured at age 19, was 21.3% for kids who’d not had anesthesia, 23.6% for those exposed once, and 36.6% for those with multiple exposures, according to the study.

But what other factors might be at play? For starters, as noted in the study itself, “…the underlying condition necessitating the surgery or a coexisting disease that could confound the relationship between anesthesia/surgery and neurodevelopmental outcomes.”

Indeed, it’s impossible to control for the influence of the surgery itself, says Dr. David Reich, chairman of anesthesiology at Mount Sinai School of Medicine. “Surgery causes trauma to tissues, inflammation, and blood loss. Postoperatively, there are variable degrees of inflammation, disability, and pain. The skill of the surgeon and the experience of the team before, during, and after surgery all vary widely and are difficult to quantify.”

Furthermore, asserts Reich, “anesthesia is not a ‘black box.’ There are wide differences in blood pressure, oxygen, carbon dioxide, and levels of acidity that influence brain blood flow and flow to other tissues of the body.” In fact, many of the drugs and techniques used today were not even available when these surgeries currently under review took place back in the 1970s and ’80s. Halothane, for example, then the predominant anesthetic agent for children, is now rarely, if ever, used in the United States, says Reich.

To arrive at their results and draw this new conclusion, the Mayo Clinic’s Dr. Randall Flick and his colleagues analyzed more than 8,500 participants from one town in Rochester, Minnesota, born between January 1976 and December 1982. The data analysis was fully adjusted for health status by taking advantage of access to complete medical charts for all members of the study. Children who did not provide research authorization, left the district before age 5, or tested severely intellectually disabled were excluded from the sample.

And perhaps the timeframe during which these surgeries took place is the most important caveat to note. This new study is a study of association. “Despite the fact that data were collected prospectively,” says Reich, “this is retrospective research, because the idea for the research emerged decades later. Even with strong independent statistical findings, there is no way to be certain in a retrospective cohort study that the observations were not influenced by some [other] factor not studied, such as blood loss during surgery.”

The bottom line: Knowing that young brains are especially susceptible to the affects of anesthesia, some early surgeries might be delayed, thereby preventing future learning disabilities in some children.

soundoff (37 Responses)
  1. JC

    My son had five major surgeries before the age of one. Three where mess-ups at a regional hospital before we transfered to a recognized children's hospital. We stopped counting the little procedures. Our regional hospital, like most like them, didn't even have pediatric anesthesiologists!

    I read about similar studies back then and was very worried. Our state cut early intervention due to the recession, so we lived off of tuna fish and white bread for a year while funding our own speach therapy at $200/week. Whatever it means he now scores in the >99th percentile in verbal comprehension – but there are many types of learning disabilities. What is amazing is how fragmented knowledge is in the medical profession and how hard you have to fight the 'system' as a parent.

    October 3, 2011 at 13:17 | Report abuse | Reply
    • Blossie

      Most regional or community hospitals do not have pediatric anesthesiologist. If you need surgery it is best to go to a pediatric hospital

      October 3, 2011 at 14:46 | Report abuse |
    • JC

      Blossie – I think that was our big lesson: Go to a highly ranked Children's Hospital (US News & World Report ranks them annually). Chances are that your kid will need fewer surgeries and therefore less exposure to anesthetics.

      October 3, 2011 at 18:36 | Report abuse |
  2. Blossie

    I can just see the lawsuits, because everyone whose child did not get into Harvard suing.

    October 3, 2011 at 14:40 | Report abuse | Reply
  3. Lily

    Interesting info, and not entirely surprising... will be interesting to see if this holds with more recent results, with the changes in anesthesia and improved surgical techniques.

    Hopefully, since some kids will not be able to put off surgery until later or will have better outcomes if it's done sooner, we'll come up with ways to mitigate any negative effects from anesthesia/surgery.

    October 3, 2011 at 14:57 | Report abuse | Reply
  4. Michel

    If you can't control for factors such as blood loss, oxygen levels, etc., how can the results be meaningful enough to warrant any conclusion other than more study is needed? Even the exclusions could be significant. How was health status objectively adjusted? Extrapolating conclusions based on data that is 30+ years old seems weak. I find it strange that learning disability assessments were made at the age of 19 when many other variables have been at play during the subjects' lives–such as poverty and poor nutrition, exposure to environmental variables such as lead paint, etc.– or is that how long it took for anything to show up in the statistics? Disappointed in the quality of this study, or at least how it appears as summarized in this article. Hope there is more work done that will yield more meaningful, defensible results. Parents would like that.

    October 3, 2011 at 15:41 | Report abuse | Reply
    • JC

      Like I mention below, the entire field of epidemiology is correlational. You can never control for everything with living subjects, and you can do even less with human subjects (the later for ethical reasons). The most important thing that they did was to eliminate the severely mentally disabled – whose inclusion biased mean IQ scores (toward the same conclusion) in past studies.

      What you may not realize is that this epidemiology data corroborates strengthening theories of apoptic neurodegeneration, and child development that make increasing sense and are backed up by lots of animal testing.

      I have very good reasons not to want to believe this study as I really have something to lose – but I can’t help but find the case compelling enough.

      October 3, 2011 at 18:31 | Report abuse |
  5. HurdyGurdy

    Oh NO !
    What will the medical industry do....
    You mena We wont able to whack everyone with Versed the minute they become 'unmanageble...re: interrupting me in the staff room watching American Idol"
    Without Vitamin "V" we might actually get sued or at least people would finally know what kind of clowns we really are.

    October 3, 2011 at 15:42 | Report abuse | Reply
  6. swlabr

    Read the study skeptically: http://pediatrics.aappublications.org/content/early/2011/09/28/peds.2011-0351.full.pdf. The investigators do not claim a new cause/effect relationship between anesthesia and learning disabilities, but rather they "cannot exclude the possibility" of a relationship based on the data. Also, remember that kids are anesthetized today quite differently from thirty-plus years ago. Nevertheless, the concern stands to reason.

    October 3, 2011 at 16:36 | Report abuse | Reply
    • JC

      If you read the body of work that the paper references you will come across the theoretical and animal model experimental studies on the subject of apoptotic neurodegeneration. This body of work suggest and provides evidence for the causal mechanism.

      Epidemiology, such as the study mentioned in the article, is always correlational. Nonetheless, epidemiological data combined with emerging theories in neuro-development along and animal model studies is, lamentably, a pretty OK case. If anything they understate the evidence.

      October 3, 2011 at 18:08 | Report abuse |
  7. BW42

    "young brains are especially susceptible to the affects of anesthesia"

    "effects", not "affects."

    October 3, 2011 at 18:27 | Report abuse | Reply
  8. Jo

    Are there safer alternatives though? I guess you have to way up the risks of this compared to the risks of not having the surgery.

    October 4, 2011 at 00:29 | Report abuse | Reply
    • Red

      To what extent do surgeries like ear tubes REALLY help with outcomes? I hope that we start seeing a shift towards more evidence-based indications for surgery in children. In my experience ENT surgeons are among the culprits who promote surgeries of dubious value most often, scaring parents into consent: hopefully parents will be more careful in future, and ask difficult questions.

      October 4, 2011 at 10:34 | Report abuse |
  9. cheesecake

    I guess that explains away the level of retard in Americans these days.

    October 4, 2011 at 09:59 | Report abuse | Reply
  10. bda

    I wonder if maybe the increased use of drugs during childbirth may be linked to the increase in autism and other learning differences.

    October 4, 2011 at 13:32 | Report abuse | Reply
  11. Zerg Cerebrate

    Correlation =/= Causation.

    I'll bet kids requiring multiple surgeries had something intrinsically wrong with them.

    This is going to be the next fiasco like vaccinations causing autism (the investigators that made that claim has been discredited and publicly reprimanded by the scientific community for falsifying data.)

    October 4, 2011 at 13:42 | Report abuse | Reply
    • Red

      If anything, they have been too cautious in disseminating this information. Most, if not all the researchers in this field have been extremely cautious about this, to the extent that this issue, which has been festering since 2003, has not been adequately funded, while millions of children are potentially being put a risk.

      The pendulum has swung too far in the other direction after the autism-vaccine hoax.

      October 4, 2011 at 16:24 | Report abuse |
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