Patients coming in for surgery at Hospital for Special Surgery (HSS) are often fretful before their procedure! But, in the case of pediatric patients, additional concern comes from parents about the impact anesthesia has on their child’s developing brain. Mild, short-term sleepiness and grouchiness are the most common side effects of anesthesia in children, but recent studies suggest that repeated, long-term exposure to anesthesia in children aged three years and younger may negatively impact brain development. Scientists are calling this ‘neurotoxicity.’
In 2016, the Federal Drug Administration (FDA) released a warning concerning general anesthesia use in children based on this research – you may have even heard about it in the news. My colleagues and I within the Pediatric Anesthesia community are often asked about neurotoxicity, and we spend enough time with pediatric patients and their parents to understand and share their concerns. Even though the research is still developing, there are a few key takeaways for concerned parents facing a decision about anesthesia for their child:
- Ask your child’s surgical team about the anesthetic At HSS, every physician anesthesiologist has specialized training in regional anesthesia for orthopedics. Regional anesthesia, such as epidurals, spinals, and nerve blocks, enables anesthesiologists to use less of the medication that researchers suggest may cause long-term negative effects on the brain. These techniques numb specific parts of the body being operated on and luckily, orthopedic procedures are especially suited for regional anesthesia—furthermore, sometimes it can be used as the primary mode of anesthesia. But even if your child needs general anesthesia, our physicians take every opportunity to minimize exposure to the general anesthesia medications listed in the FDA Warning. You and your child will meet your anesthesiologist before surgery, and you can always ask for a consult with a physician to discuss your concerns, in person or via telephone.
- Don’t delay or avoid necessary surgery. Many of our young pediatric orthopedic patients, for whom neurotoxicity is most concerning, have conditions that need to be addressed sooner rather than later. The potential impact of general anesthesia is very well-understood among our team, and any physician within the Department of Anesthesiology, Critical Care & Pain Management works in tandem with the surgeon to ensure the best approach is taken for your child’s specific case. Every member of the surgical team has your child’s best interests at heart and will only recommend surgery if it is necessary.
- Limited exposure is safe. While our physician anesthesiologists are all experts in regional anesthesia, some cases require general anesthesia, even in tots. There is good news for parents though. Short-term exposure to general anesthesia (less than three hours) is considered safe among scientists who research the impact of anesthesia on young patients. For those children who need to undergo several procedures, our anesthesiologists and surgeons create a treatment plan collaboratively to limit the total amount of time they are under anesthesia.
At HSS, we are dedicated to providing your child with the best, most optimal care for their musculoskeletal condition. While the long-term impact of general anesthesia on kids is still being studied, every member of the HSS team works together to mitigate these issues through the use of our specializations custom-made to benefit your child’s orthopedic procedure.
Dr. Kathryn (Kate) DelPizzo is the director of pediatric anesthesia within the Department of Anesthesiology, Critical Care & Pain Management at Hospital for Special Surgery. She is part of the Pediatric Regional Anesthesia Network (PRAN), a group dedicated to sharing results and research into the use of regional anesthesia in pediatric patients.