Recently, I had the opportunity to care for a woman that was in her 26th week of gestation, and the subject of the anesthetic effects on her developing fetus cam up during the discussion on informed consent. I had recently read a summary on the current state of the research on the clinical evidence for any effect of anesthesia on the developing brain, and I was able to relay that information to her, (Anesthesiology 4 2018, Vol 128, 840-853) from which I will summarize for this post.
Let’s start by stipulating that because of the potential for any effect on the neurodevelopment, we should all pause prior to agreeing to elective surgery in our children. However, as suggested in the labeling change regarding the safe use of anesthetic and sedative drugs (http://www.fda.gov/Drugs/DrugSafety/ucm532356.htm) brief exposure is probably safe and encourages the healthcare professional to consider the risks of delaying the surgery.
We have known for some time that surgical exposure early in life increased the risk of neurodevelopmental problems. However, it was originally thought that there was no connection to anesthetic toxicity. Recent laboratory evidence has shown that anesthetic exposure can modulate various aspects of brain development.
The problem with these preclinical studies is that they are very difficult to translate into useful information to guide the anesthesiologist in safe anesthetic practice. The reason for this is that when applied to humans, there are several confounding factors to consider:
What we do know is the following: (excerpted and paraphrased from Anesthesiology 4 2018, Vol 128, 840-853)
Any time your child has surgery, it is a very stressful period for the child and parent. It is reasonable for the parent to be concerned about these issues. Any surgical or anesthetic intervention in your child should prompt a through discussion of the anticipated benefits of that surgical procedure and should be weighed against the potential surgical and anesthetic risks of that procedure.
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