Reassuring News for Parents: Short General Anesthesia Unlikely to Affect Cognitive Development in Young Children
Many parents worry before their child's surgery:
"Will general anesthesia affect their brain development?"
A research team led by Professors Lee Ji-hyun and Ji Sang-hwan of the Department of Pediatric Anesthesiology and Pain Medicine at Seoul National University Hospital has published reassuring results.
Here's some heart-warming scientific news to ease parents' minds.
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Seoul National University Hospital: "Short General Anesthesia in Children Does Not Affect Intelligence or Behavioral Development"
- Prospective, double-blind, randomized clinical trial conducted on 400 patients under 2 years of age undergoing single surgery
- No difference in neurological development even with a 30% reduction in inhaled anesthetic dosage… Short-term safety proven
A large-scale clinical study conducted by Professors Lee Ji-hyun and Ji Sang-hwan's research team at Seoul National University Hospital on children under the age of 2 has confirmed that short general anesthesia does not negatively affect children's intelligence or behavioral development. Furthermore, there was no difference in cognitive abilities or emotional and behavioral development even when the concentration of inhaled anesthetics was reduced by approximately 30% by using adjunctive agents during general anesthesia. This study is significant in that it provides scientific evidence for the 'safety of pediatric general anesthesia,' which is of utmost concern to parents.
Every year, millions of children worldwide receive general anesthesia for surgery or procedures. The most common method involves using inhaled anesthetics, often referred to as 'anesthesia gas.' However, parents worry that anesthesia at a young age may cause problems with brain development. Some animal studies have reported that inhaled anesthetics can cause nerve cell damage or cognitive decline, and the U.S. Food and Drug Administration (FDA) warned in 2016 that prolonged (3 hours or more) or repeated general anesthesia in infants and young children under the age of 3 may be harmful to brain development.
However, clinical studies to date have confirmed that single or short general anesthesia does not leave significant problems in long-term cognitive function. However, there was insufficient evidence as to which anesthetics are safer, or whether it is helpful to reduce the dosage of inhaled anesthetics by co-administering multiple drugs. Therefore, the research team conducted a study to verify the effect of 'balanced anesthesia*' using the sedatives dexmedetomidine and remifentanil, which are known to have low neurotoxicity, together with the inhaled anesthetic sevoflurane, on children's neurodevelopment.
*Balanced anesthesia: A method of reducing side effects by using several drugs together to maintain the anesthetic effect instead of a single drug
This study is a prospective, double-blind, randomized clinical trial conducted from 2020 to 2023 on 400 patients under the age of 2 undergoing single surgery. Only short surgeries of approximately 2 hours or less were included, and participating patients were randomly assigned to two groups. One group used only inhaled anesthetic (sevoflurane) ('single group'), and the other group used the same sevoflurane with adjunctive agents (dexmedetomidine, remifentanil) ('combination group').
Subsequently, when the patients reached 28-30 months of age, non-verbal intelligence tests (K-Leiter-R) and parent-reported behavioral and emotional development assessments (CBCL) were performed to compare developmental status. A total of 343 patients were ultimately included in the analysis.
The analysis showed that the average anesthesia time was approximately 75 minutes in both groups, with no difference. The average concentration of inhaled anesthetic in the combination group was 1.8%, approximately 30% lower than in the single group (P<0.001).
However, no statistically significant differences were observed in any of the evaluation items, including intelligence quotient (IQ), behavioral and emotional development, and language ability (P>0.05). In other words, in short, single surgeries, the anesthetic method of reducing inhaled anesthetics while using adjunctive agents did not bring clinically significant differences in children's short-term cognitive or emotional development.
Previous major overseas studies such as PANDA (Pediatric Anesthesia Neurodevelopment Assessment), MASK (Mayo Anesthesia Safety in Kids), and GAS (General Anesthesia compared to Spinal anesthesia) mainly focused on 'whether or not anesthesia was performed' or 'the difference between general anesthesia and spinal anesthesia.' On the other hand, this study is differentiated in that it directly verified the safety of 'balanced anesthesia,' which controls the concentration of inhaled anesthetics widely used in actual clinical practice in children requiring general anesthesia. The results of this study are expected to be used as a basis for selecting drugs and adjusting doses during pediatric general anesthesia in the future.
Professor Ji Sang-hwan (Department of Pediatric Anesthesiology and Pain Medicine) said, "These results are an interim analysis at 28-30 months of age, and so far, short general anesthesia does not appear to affect children's cognitive or emotional development." He also stated, "We plan to finally verify long-term safety through follow-up evaluations at 5 years of age in the future."
Professor Lee Ji-hyun (Department of Pediatric Anesthesiology and Pain Medicine) said, "This study is an important result that objectively verifies the short-term neurodevelopmental effects of single general anesthesia in a real clinical environment, and shows that currently widely used inhaled anesthetics are relatively safe." She added, "We hope that these results will alleviate the anxiety of parents and medical staff, and contribute to the establishment of safety guidelines for pediatric anesthesia in the future."
The results of this study were published in the latest issue of the international academic journal 'Anesthesiology' (IF 9.1).
Source :https://blog.naver.com/chsnuh/224050824761
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