Single exposure appears to cause no cognitive harm in healthy children, but continued research needed in other scenarios

San Francisco, CA (June 17, 2016) A recent study concluded that very young, healthy children undergoing short surgical procedures requiring a single exposure to general anesthesia did not exhibit any effect on the cognitive outcomes tested, according to SmartTots, a public-private partnership of the International Anesthesia Research Society and the U.S. Food and Drug Administration (FDA). However, the group cautioned that more research is needed to identify problems that might exist under different circumstances.

The multi-center PANDA (Pediatric Anesthesia Neurodevelopment Assessment) study was led by researchers at Columbia University Medical Center and New-York-Presbyterian/Morgan Stanley Children’s Hospital. SmartTots was a partial funder of the study, which was published in the June 7, 2016 issue of the Journal of the American Medical Association.

The study, which compared 105 otherwise healthy children who were given general anesthesia for inguinal hernia surgery before the age of 3 with siblings who had not received anesthesia before age 3, showed no significant difference in IQ scores between the siblings when assessed between the ages of 8 and 15. The period of 0-3 years old is a critical time in the development of a child’s brain; animal studies and some previous epidemiological studies have shown general anesthesia to have a harmful effect when given during periods of rapid brain development. While this study included healthy children with a single exposure to general anesthesia, a different patient population, including children with a more complicated medical history and with multiple general anesthesia exposures, may show different results.

The siblings in the PANDA study were also tested for a host of secondary outcomes, including memory, learning, attention, language and behavior. Researchers found no statistically significant differences in these categories after accounting for gender differences, with the exception that exposed children had more instances of abnormal “internalizing behavior,” which refers to problems such as anxiety and social withdrawal.

“We’re encouraged by these results,” said Beverley Orser, MD, PhD, professor of anesthesiology at the University of Toronto and a member of SmartTots’ Steering Committee and Scientific Advisory Board. “The PANDA study was well designed, and supports the conclusion that healthy young children undergoing a single, short-duration exposure to general anesthesia may not be at risk. Unlike some of the previous epidemiological studies, the PANDA study was able to account for variables such as surgery, medical condition, and length of exposure, which is extremely important.”

One previous study, General Anesthesia Compared to Spinal Anesthesia (GAS), showed no difference in cognitive function on preliminary testing at age 2 between children undergoing regional anesthesia as infants for an inguinal hernia surgery and those given general anesthesia for the same procedure. The primary goal of the GAS study is to measure performance at age 5.

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