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Anesthesia in young kids may carry developmental risks
Children who have anesthesia before the age of 3 may be at higher risk of developmental delay issues later in life.
August 20th, 2012
12:01 AM ET

Anesthesia in young kids may carry developmental risks

While surgery carries risks for anyone, “going under” can have some particular risks for the very young.

A study coming out in the September issue of Pediatrics finds that children who have anesthesia before the age of 3, are at a higher risk for developmental delay issues later in life.

The study looked at more than 2,600 children in Australia who were tracked as part of the Raine Study. Authors found that by the age of 10, children who’d been exposed to anesthesia at a young age were more than twice as likely to have developmental issues with listening and speaking comprehension.

"We can’t determine if the cause is due to anesthesia, surgical stimulus, or the medical condition. It could be another factor entirely. We just know there’s a difference,” says Dr. Caleb Ing, assistant professor of pediatric anesthesiology at Columbia University Medical Center and lead author of the study.

Dr. David Warner, professor of anesthesiology at Mayo Clinic, has also been studying the impact anesthesia has on development. While he was not part of this study, Warner agreed that surgery and anesthesia introduce a whole host of factors that may impact a child’s developmental outcome.

“It may be the surgery; it could be the underlying illness,” explained Warner.

Previous studies have linked anesthesia in young children to increased risks in learning disabilities and ADHD. However this is the first study that has used a battery of neuropsychological tests to determine developmental delay. Previous studies relied on test scores, physician’s diagnoses  and medical records.

The children in the study were given tests that assessed their listening, speaking, and abstract reasoning skills. Children who had had anesthesia were 1.87 times more likely to have listening comprehension issues, 1.72 times more likely to have problems with speaking and 1.69 times more likely to have abstract reasoning delays. The combined risk factor for both listening and speaking issues was 2.11.

The group was also tested for behavior and motor function, but the authors found no significant difference in these skills between children who’d had anesthesia and those who hadn’t.

The authors also compared children who had anesthesia once, versus 52 children in the study group who had it multiple times.

“We did see a difference in children with single and multiple exposure, but we couldn’t statistically prove a difference, because we need more patients that had multiple exposures than were available in this study,” said Ing.

But while there are risks, Ing also warned that further study needs to be done. “We don’t enough evidence to change our current practices,” he explained.

“Anytime you decide to do a procedure, you need to understand what the real benefits are," Warner says. "Parents need to ask, 'Do we really need to do this? How is this going to benefit my child?' In the vast majority (of cases), in kids this age, the benefits are real. But the risk is potential and not definite."

He added, “It’s been established as a risk factor, and needs to be part of the conversation as parents talk to their doctors.”


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soundoff (62 Responses)
  1. JaeB

    "We can’t determine if the cause is due to anesthesia, surgical stimulus, or the medical condition. It could be another factor entirely. We just know there’s a difference",....
    Considering the above statement in the article, it would have been more intelligent (and correct) not to target anesthesia alone and put fear into people with the headline as written – "Anesthesia in young kids may carry developmental risks. "

    August 20, 2012 at 09:49 | Report abuse | Reply
    • Eggplant

      Agree.

      August 21, 2012 at 16:57 | Report abuse |
    • Steve Anderson

      There is more background to this story than meets the eye. Scientists have shown a statistically significant correlation between anesthesia and neurocognitive issues in animals. The FDA has also convened two national advisory panels who have conducted meta-analyses and determined a significant correlation between (i) one dose of general anesthesia in one study and (ii) two doses of general anesthesia. WHen combined with the work of the Mayo and this Australian study, there is a pattern emerging which may target anesthesia. The big question is the type and duration of the general anesthetic.

      August 22, 2012 at 12:20 | Report abuse |
  2. my reply

    correlation does not imply causation. there is usually a third variable involved.

    August 20, 2012 at 10:57 | Report abuse | Reply
    • Jimmy

      This is a terrible headline. Children who have developmental delays are more likely to have surgery when they are younger. Many chidlren who have chromosomal abmormalities, for example, will end up needing surgery for various reasons (G-tube, trach, etc.). Did the study control for these? Even if they did, I imagine it would be very difficult to completely control for this. Also when you look at the Odds Ratios, while they are probably significant they are that impressive. I'm not sold.

      August 20, 2012 at 17:13 | Report abuse |
  3. LisaW

    Feeling really bad for letting my son going through a general anesthesia for dental procedure when he was 4. But two dentists recommended it and it was done in a Children's Hospital. Does this mean I will always be haunted that it may have impaired his development? Sad.

    August 20, 2012 at 12:17 | Report abuse | Reply
    • Sally

      My son had a Hernia operation when he was 2 and a half. He is a perfectly normal, College Graduate with a Career! Don't worry about this article!

      August 20, 2012 at 14:59 | Report abuse |
  4. c s

    The simple truth is that anesthesia is a poison that must be administered with extreme care. It makes surgery possible but let no one underestimate its dangers. This one of the reasons that anesthesiologists have some of the highest insurance costs; sometime they make mistakes and kill people. In no way am I suggesting that anesthesia not be used, but everyone should understand that it takes great care to use it on patients. Can it affect children more than adults? Due a child's smaller body, there exists a smaller variance in dose between what is safe and necessary and what is dangerous. So I am not surprised that children might have a higher fatality injury/death during surgery. However without anesthesia, most surgery would be impossible.

    August 20, 2012 at 15:00 | Report abuse | Reply
    • MJ

      As an Anesthesiologist I can unequivically state that your comment that "anesthesiologists have some of the highest insurance costs" is false. This may have been true 30 years ago but not today. Advancements in patient safety ie better monitoring and air way management devices, have drastically reduced complications from anesthesia and therefore malpractice costs. If you want to find some one paying huge malpractice costs talk to an OB or a Neurosurgeon.

      August 20, 2012 at 15:45 | Report abuse |
  5. kansascindy

    Anesthesia in children is handed out like candy-dentists like to fill cavities this way in the hospital. Of course, I am sure it is more profitable, too. When it was suggested for my son, we called the hospital to see if a full fledged anesthesiologist would be doing the procedure. No, they would not guarantee that-just a nurse anesthetist. When we finally consulted with an anesthesiologist, he told us not to do it. Sometimes, they put the tube down the wrong pipe and brain damage the child. He said intubating children is much more difficult and requires more skill and has more risks involved.

    August 20, 2012 at 21:06 | Report abuse | Reply
    • Ann Theresa

      Of course an anesthesiologist would say that....just trying to justify his exsistance and pay check. Some professional are just threatened that their job may be replaced. There are certain steps taken to ensure the intubation tube is in the right place and it is properly ventilating the lungs and not the stomach...and of course, there are good and bad in all fields....

      August 20, 2012 at 22:01 | Report abuse |
    • Anna

      (n.b.–the anesthesiologist talked the patient/family out of proceeding and would have thus denied himself payment for those professional services. The claim that the recommendation is 'money'-directed is seemingly baseless.)

      August 21, 2012 at 11:18 | Report abuse |
    • Steve B

      i dont know who administered the drug at ku med center but im sure that this is why he is the way he is today. he was 6 months old when this happened.

      August 21, 2012 at 20:15 | Report abuse |
  6. AR

    As an adult who has undergone several surgeries with general anesthesia I do not find this study surprising at all. I always feel like my brain has been "scrambled" for several weeks after surgery. I have often wondered what the lasting influence is and feel that it is hard to imagine there is none. When my daughter had several procedures with a general at a young age I spoke to her pediatrician about this and was assured it was not an issue and found this very surprising. I hope more research will be done to get to the bottom of the issue and assist parents and doctors with information for informed decisions.

    August 20, 2012 at 21:15 | Report abuse | Reply
  7. 8Jah

    What this article does not mention is that this is just another in a growing list of published studies in humans and in animals indicating that anesthesia negatively affects development. Studies on humans are correlational for ethical reasons; however carefully controlled studies have been performed in animals. For example, in parakeets they found the order of development could be rearranged with anesthesia (w/o surgery of any kind).

    August 20, 2012 at 22:06 | Report abuse | Reply
  8. MashaSobaka

    A bad headline for a marginally written article. That said, it'll be interesting to see where this goes. If only because I freaking hate anesthesia and will use any excuse, no matter how remote, to avoid it.

    August 20, 2012 at 23:18 | Report abuse | Reply
  9. Sandy

    Had two surgeries before age of six. Have always had memory problems. Also had a concussion and skull fracture at age eight. Now I know why I'm hopeless.

    August 21, 2012 at 08:41 | Report abuse | Reply
  10. Name*suriyah

    Would appreciate risk stratification by length of anesthesia and disease. Are these 30 minute endoscopies or kidney transplants? Are they in children just removing tonsils/adenoids or in those withmultiple health issues?

    August 21, 2012 at 11:00 | Report abuse | Reply
  11. Anna

    As a board-certified anesthesiologist I believe the study correlations quoted here, but what has caused the correlation in the study population cannot be extrapolated to individuals. In the US, there are just too many other factors for which too few people are willing to control: Example: Who is administering the anesthetic?--a properly trained board-certified anesthesiologist, or is it a nurse? Or a dentist? Or a physician board-certified in 'something else', but with miniscule anesthesia training and no certification whatsoever? The fact is, in the US today patients demand their medical care NOW and CHEAP...but I can tell you it is just as rare as 'hen's teeth' to have the parent of a child STOP and request a board-certified anesthesiologist administer the anesthetic before a major or a minor surgery. The last twenty years have seen the demand for a high standard disappear......so fast and cheap translates to a nurse anesthetist hurrying a child into and out of an operating room with little regard to dosing, exogenous factors, preexisting conditions, etc. Just as the work from Duke U concerning cognitive dysfunction after anesthesia has been largely ignored, so will this.

    August 21, 2012 at 11:13 | Report abuse | Reply
    • 8Jah

      Your complaints are fair. Parents have no way of knowing who to trust or what certifications to request when their child needs surgery. Even very intelligent parents would not have the occasion to know the roles played by an anesthesiologist, a surgeon, a cardiologist, a neonatologist,... The only thing that they can do is to trust the hospital. They also don't want it FAST and CHEAP (fast and cheap are actually the same thing), they have no option but to have it CHEAP. So that is not volitional.

      I share your opinion that a good pediatric anesthesiologist is a critical part of the surgery team, and that parents need to know this. The ONLY reliable way for parents to do this is to take their kids to a reputable CHILDREN'S HOSPITAL. Parents, only let your children have surgery in a CHILDREN's HOSPITAL that is ranked in US NEWS and World Report's top 50 Children's Hospitals. These hospitals ensure that all their surgical teams have pediatric board certifications and the proper training. You may love your doctors at another hospital, but it is what you don't know that is hurting your children.

      August 21, 2012 at 12:44 | Report abuse |
    • 8Jah

      I meant that your complaints aren't fair

      August 21, 2012 at 12:45 | Report abuse |
  12. Fred MD

    Agree with the above. Already this week this physician has gotten half-a-dozen emails/complaints/issues about my practice's "billing"...........but not a word about improving, addressing, updating or better managing anyone's health. Welcome to third-party medicine where science is in the back seat and the money is doing the driving!

    August 21, 2012 at 12:06 | Report abuse | Reply
    • Edinho

      It sounds like you are taknig the long road there. Then you'll have to get your BSN and then get accepted to a CRNA program and finish it. Go for your BSN now, forget the LPN step.

      September 11, 2012 at 19:17 | Report abuse |
  13. Tom, Tom, the Piper's Son

    Anesthesia is dangerous for everyone. That’s why there is an entire field of medicine dedicated to it. Just more scare tactics.

    August 21, 2012 at 16:25 | Report abuse | Reply
    • Cristian

      If I may be so bold I will tell you how to tweak your plan a bit. First thing is yes you need at least one year acute care exp. That experience must be as an RN not an LPN. An LPN canont provide Acute care to anyone in any facility in this country because their license does not permit them to perfom many necessary skills.Next thing is the quickest route is this First get your Bachelors then go to work for one year then apply to CRNA school.I know that you prob think an Associate is quicker, but in reality it will take you just as long to get your ADN as your BSN. The reason is that most colleges will make you take all prereqs then you can apply to be admitted to the nursing program and if or when you get selected you start your two years from there. There are also waiting lists to contend with. Most four year colleges admit on merit each semester. You either get in or not.Good Luck on your Decision! Great career path to invest in.

      September 11, 2012 at 18:56 | Report abuse |
  14. Cleft Kid

    My sister and I are both cleft lip and cleft palate patients. We both had surgeries starting at age 9 weeks, and had over 16 each throughout the next 18 years. We are both strong, intelligent, and beautiful young women attending the same top ranked university. This article was very misleading, and as a student involved in research, it is upsetting that this study is cited with such certainty. There need to be many more studies before anyone takes this seriously.

    August 22, 2012 at 01:23 | Report abuse | Reply
    • J.Daddy Swagga 100 degrees

      pat yourself on the back a little bit more why don't yah

      August 23, 2012 at 18:58 | Report abuse |
  15. J.Daddy Swagga 100 degrees

    dang that's probably why my sister had hearing and speaking problems, cause she had surgery when she was 1 years old.

    August 23, 2012 at 18:57 | Report abuse | Reply
  16. Little Frogs In A Big Pond

    I suspect ear tubes are the most common reason for anesthesia in small children. Would anyone be surprised that kids who had ear tubes also had language and listening problems? Of course, how much worse would the problems be without the tubes?

    August 23, 2012 at 21:50 | Report abuse | Reply
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    September 14, 2012 at 01:51 | Report abuse | Reply
  18. mel

    My daughter had surgery at 10 months at Children's in Boston and we were told 3 years ago that she may be delayed up to three months while she is healing but she would catch up. She was under almost 3 hours which was the scariest 3 hours of my life but she was a trooper .We really will not know if her cognitive abilities are affected until she is in school full time, .I had her seen by early intervention at 2 and she came out fine without services and was screened before preschool and was fine. I questioned her processing but time will tell.

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