GENERAL ANESTHESIA: IS IT SAFE FOR NEWBORNS, INFANTS AND YOUNG CHILDREN ?

Jasminka Nancheva, Viktor Kamnar, Andrea Nanceva, Daniela Georgieva, Antonio Georgiev, Alan Andonovski

Abstract


The exposure of neonates, infants and small children to general anesthesia is becoming a common occurrence. Accumulating preclinical data indicate that exposure to commonly used general anesthetic agents during key periods of brain development in this population(between late gestation and 3 to 4 years of age,) can lead to apoptotic neurodegeneration, synapse loss, and cognitive and neurobehavioral deficits that persist as the organism matures. New work suggests that infants and small children undergoing some types of surgery could have better recovery if they receive regional anesthesia rather than general anesthesia.                                           In response to this concerns, the Food and drug administration (FDA) and the International Research Society in anesthesia (IARS) started an initiative called Smart Tots (Strategies for Mitigating Anesthesia- related neuro Toxicity in Tots) which examine the effects of anesthesia on brain development. Also another two major prospective studies are ongoing in children : PANDA (Pediatric Anesthesia Neurodevelopment assessment Study )project is a large, multi-center study based at the Morgan Stanley Children’s Hospital of New York at Columbia University, and another one is GAS study which is a multisite randomized controlled trial comparing neurodevelopment outcomes in infant receiving general anesthesia compared to spinal and other regional anesthetics to the stress response to surgery.

The findings from these studies will help researches to design the safest anesthetic regimens  and  to develop the new and safer anesthetic drugs for use in pediatric  medicine.


Keywords


paediatric anesthesia, newborn, infant, small children, neurotoxity risk,neurocognitive outcome

Full Text:

PDF

References


Sun LS, Li G, Dimaggio C et al. Anesthesia and neurodevelopment in children: time for an answer? Anesthesiology.2008;109:757–61.

Jevtovic-Todorovic V, Hartman R.E, Izumi Y et al. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–82.

Lunardi N, Ori C, Erisir A, Jevtovic-Todorovic V. General anesthesia causes long-lasting disturbances in the ultrastructural properties of developing synapses in young rats. Neurotox Res. 2010;17(2):179–88.

De Roo M, Klauser P, Briner A et al. Anesthetics rapidly promote synaptogenesis during a critical period of brain development. PLoS One. 2009;4(9):e7043.

Briner A, De Roo M, Dayer A, Muller D, Habre W, Vutskits L. Volatile anesthetics rapidly increase dendritic spine density in the rat medial prefrontal cortex during synaptogenesis. Anesthesiology.2010;112(3):546–56.

Crosby G, Culley D.J, Patel PM. At the sharp end of spines: anesthetic effects on synaptic remodeling in the developing brain. Anesthesiology. 2010;112(3):521–3.

Weiss M, Gerber AC. Rapid sequence induction in children—it's not a matter of time. Paediatr Anaesth. 2008;18(2):97-9.

Zdravkovic I, Jankovic R. Safe extubation and reintubation in operatory room and ICU patients. Sanamed. 2014; 9(1):89-98.

Peiris K, Fell D. The prematurely born infant and anaesthesia. Contin Educ Anaesthe Critical Care Pain.2009;9(3): 73-7.

Brett CM,Davis PJ, Bikhazi G. Anaesthesia for neonates and premature infants. In: Motoyama EK, Davis PJ , editors. Smith's Anesthesia for Infants and Children. Philadelphia: Mosby Elsevier. 2006;p. 521-70.

Sprung J, Flick RP, Katusic SK et al. Attention deficit/hyperactivity disorder after early exposure to procedures requiring general anesthesia.Mayo Clinic Proc.2012 ;87(2):120-9.

American Society of Anesthesiologists (ASA). Researchers determine best anesthesia option for infants." ScienceDaily. ScienceDaily, 19 May 2015. .

Wilder RT, Flick RP, Sprung J et al. Early exposure to anesthesia and learning disabilities in a population- based birth cohort. Anesthesiology. 2009;110(4): 796-804.

Gupta A, Saha U.Spinal anesthesia in children. J Anaesthesiol Clin Pharmacol. 2014;30(1): 10–8.

Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet. 2016;387(10015):239-50. 16.Ko WR, Liaw YP, Huang JY et al. Exposure to general anesthesia in early life and the risk of attention deficit/hyperactivity disorder development: a nationwide, retrospective matched-cohort study. Paediatr Anaesth.2014 ;24(7):741-8.

Dimaggio C, Sun LS, Li G. Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort. Anesth Analg. 2011;113(5):1143-51.

Flick RP, Katusic SK, Colligan RC et al. Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics. 2011;128(5): e1053–61.

Frawley G, Bell G, Disma N et al. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study—Comparing Apnea and Neurodevelopmental Outcomes. Anesthesiology. 2015;123(1):55-65.

Davidson AJ, Morton SN, Arnup JS, et al. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study—Comparing Apnea and Neurodevelopmental Outcomes, A Randomized Controlled Trial. Anesthesiology. 2015;123(1):38-54.

Ramsay JG, Rappaport BA. Smart Tots:multidisciplinary effort to determine anesthetic safety children. Anesth Analg.2011;113(5):963-4.

Nasr V, Davis JM. Anesthetic use in newborn and infants:the urgent need for rigorous evaluation.Pediatr Res.2015;78(1):2-6.




DOI: http://dx.doi.org/10.24125/sanamed.v11i2.122

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 SANAMED

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.