Is Anesthesia Safe for My Child?

Abstract

FOR YEARS, WE HAVE ANSWERED this common parental question with a resounding “Yes”—as data pointed to overwhelming safe and effective outcomes of pediatric anesthesia after implementation of intraoperative and early postoperative monitoring. However, a growing number of studies have raised concerns that anesthetics may actually be neurotoxic to the developing brain, leading to long-term changes in memory and cognition that cannot be identified during the perioperative period. These concerns have been highlighted in recent editorials in The New England Journal of Medicine, 1 Rappaport B.A. Suresh S. Hertz S. Evers A.S. Orser B.A. Anesthetic neurotoxicity—Clinical implications of animal models. N Engl J Med. 2015; 372: 796-797 Crossref PubMed Scopus (244) Google Scholar The Journal of the American Medical Association, 2 Psaty B.M. Platt R. Altman R.B. Neurotoxicity of generic anesthesia agents in infants and children: An orphan research question in search of a sponsor. JAMA. 2015; 313: 1515-1516 Crossref PubMed Scopus (44) Google Scholar and in the lay press. 3 Grady D. Researchers warn on anesthesia, unsure of risk to children. The New York Times. Febuary 25, 2015. Google Scholar Not surprisingly, parents are more frequently asking surgeons and anesthesiologists “Will anesthesia hurt my child's brain?” Furthermore, nearly half of anesthesiologists in a recent survey have been asked about this important topic by their nonanesthesia colleagues, including pediatricians, surgeons, and radiologists. 4 Ward C.G. Hines S.J. Maxwell L.G. McGowan F.X. Sun L.S. Neurotoxicity, general anesthesia in young children, and a survey of current pediatric anesthesia practice at US teaching institutions. Paediatr Anaesth. 2016; 26: 60-65 Crossref Scopus (16) Google Scholar Although we do not know how often perioperative nurses are asked this question, it is important that we understand what is known and unknown about anesthetic neurotoxicity and be prepared to answer parental concerns in a knowledgeable and supportive manner. Terri Voepel-Lewis, PhD, RN, Associate Research Scientist, University of Michigan Medical School, Department of Anesthesiology, Section of Pediatrics, Ann Arbor, MI Shobha Malviya, MD, Professor of Anesthesiology, Department of Anesthesiology, University of Michigan, Ann Arbor, MI