The Effects of Anesthesia on Children

A child being wheeled into the operating room.

As the parent of a young child who needs surgery, you may be concerned about the effects of anesthesia on your child. Until recently, the common side effects of anesthesia in children (sleepiness, grouchiness) were believed to be mild and short-term, typically lasting only an hour or two.

Are there any long-term effects from anesthesia in babies or toddlers?

Doctors and scientists have been studying the effects of anesthesia on the developing brain for more than 20 years, and published research indicates that short, brief exposure to anesthesia in patients, aged three years and under, does not cause long-term cognitive effects. However, there are concerns about young children undergoing multiple procedures or longer surgeries (greater than three hours). Scientists call this “neurotoxicity.”

In December 2016, the FDA issued a drug safety communication about general anesthesia and sedation in children younger than three years of age. The FDA requires the addition of warning labels on common anesthetic agents used for general anesthesia and sedation. These are not black box warnings, however.

Doctors who use anesthesia in procedures for young children have to use their best judgment. The warning from the FDA is not meant to delay necessary procedures for children in this age group. The doctors at Hospital for Special Surgery are up to date with the latest research and understand your concerns.

Research on the link between anesthesia and brain development has been ongoing for decades, and there is more research and investigation necessary to fully understand the risks. Animal and human studies suggest that young patients who need long surgeries (greater than three hours) or multiple surgeries before age might be at risk for learning or behavior issues later in life.

On a more positive note, recent studies in humans have indicated that a brief, single exposure to anesthesia in this age group does not have a negative impact on future cognitive ability. In addition, scientists have recognized two classes of medications that can be used with anesthesia that do not appear to have an impact on developing brains.

We understand that the decision to proceed with surgery and/or sedation on a young child is made after weighing all the benefits and risks, and that some procedures are necessary while a patient is younger than three years. At HSS, we are and have always been committed to limiting the amount of general anesthesia medications given to this age group.

While we may not be able to always avoid these medications, we can minimize them by using, whenever possible, regional (local) anesthesia and the classes of medications that have been deemed safer for this age group. However, because of intraoperative clinical decisions we can never rule out the possibility that one or more of the medications included in the FDA warnings might be used during your child’s surgery.

How can we reduce long-term effects of anesthesia in children?

At HSS, our anesthesiologists are experts in regional anesthesia – in fact, approximately 90% of joint surgeries at HSS are conducted using regional anesthesia.

Regional anesthesia is a term describing any anesthetic technique that numbs the nerves at the surgical site without having to put the entire body to sleep. Because many orthopedic surgeries are focused on one limb, regional anesthesia is often an ideal option at HSS. (This does not apply to spinal surgeries, which require general anesthesia.)

Regional anesthesia is recommended by experts to help minimize the risk of neurotoxicity. Examples of regional anesthesia include epidurals, spinals and various nerve blocks that make extremities completely numb. The doctors at HSS have used these regional anesthetic techniques extensively for more than 25 years, and have performed them expertly in children of all ages. Our experienced anesthesiologists perform hundreds of regional anesthetics or “blocks” on children every month.

Regional anesthesia not only reduces the risk of anesthetic neurotoxicity, it also has many other benefits to improve pain relief and comfort for the patient. Generally, patients require less overall anesthesia, wake up faster after surgery, experience less nausea, and usually don't need as many opioid medicines for pain after surgery.

Regardless, if surgery and/or general anesthesia cannot be avoided in your young child, you can be confident that the HSS approach will minimize your child's exposure to anesthetic agents. (Learn more information about regional pediatric anesthesia at HSS.)

What are the side effects of anesthesia in children?

Nausea and vomiting can be common side effects after anesthesia in both children and adults. The risk of experiencing these side effects depends on the type of anesthesia used, the procedure the patient has just undergone, and which medicines are used to treat pain after surgery.

Your child’s anesthesiologist has several techniques available to reduce the likelihood or the severity of nausea. Administering anti-nausea medications before, during, and after surgery can all reduce nausea. If it is possible to provide adequate pain relief during surgery with regional anesthetic techniques instead of general anesthesia, this can also help reduce nausea. Additionally, using treatment alternatives that reduce the need for additional medicines that often cause vomiting or nausea can also be of help.

Certain patients may be at higher risk for nausea and vomiting after surgery, including females, those who have experienced postoperative nausea and vomiting in the past, and those with a history of motion sickness. If you have concerns, please speak with your child’s anesthesiologist before surgery, and they will customize your child’s anesthetic plan to reduce the risk of postoperative nausea and vomiting.

Opioid medicines used after surgery for pain management can also cause side effects, including constipation, nausea, vomiting, and dizziness. Children or teens may be at heightened risk for certain side effects including itching, or feeling “loopy” or “fuzzy.” If your child experiences side effects at home after surgery, contact their surgeon. There may be methods of relieving these side effects, or a different type of opioid might work better for them.

Other uncommon side effects after surgery can include blood clots or reactions to a blood supply transfusion. HSS follows safety protocols to reduce the risk of any issues from blood transfusions and blood clots. Additionally, following instructions for movement and physical therapy after surgery also reduces the risk of blood clots. You can read more about safety information regarding these topics on our Safety and Side Effects page.

Is anesthesia safe for babies and children?

It is natural for parents to be concerned about the effects of anesthesia on their child. Our number one priority is your child’s safety, and this principle is the basis for everything that we do and every decision that we make regarding your child’s anesthesia.

On the day of surgery, you will have time to discuss your concerns with your child’s anesthesiologist. There are a few things that you can do to maximize your child’s safety: follow the instructions given to you about feeding your child on the day of surgery, answer all questions honestly, bring a list of your child’s medications, and let the doctor know if your child has had a recent cold or an episode of croup.

Regional anesthesia is another major way that HSS increases the safety of pediatric patients. Unlike general anesthesia, regional anesthesia targets the part of the body undergoing surgery. Regional anesthesia also enables our doctors to administer less overall anesthesia, and patients wake up faster after surgery with less nausea. Patients also generally don’t need as much opioid pain medicine after surgery.

Finally, if you are preparing a young child for surgery, it is important to remember that your anesthesiologist will tailor the amount and type of anesthesia your child needs to ensure he or she is safe and comfortable before, during, and after the procedure.

The FDA is encouraging physicians to discuss this topic with any parent/guardian who has a young child undergoing anesthesia or sedation. If you are considering surgery for your child at HSS, please feel free to ask your surgeon, pediatrician or anesthesiologist any questions.

Research on this topic is ongoing and new information becomes available frequently. You may find more information at SmartTots.org.

Authors

Kathryn (Kate) DelPizzo, MD
Director of Pediatric Anesthesiology, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College

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