Children who require anesthesia services before the age of three represent a broad range of medical diagnoses and circumstances. Regardless of how serious a child’s situation may be, there has been a longstanding concern in clinical medicine around the potential risks of receiving anesthesia at such a young age. Much of this concern has stemmed from animal studies where drugs used in general anesthesia show neurological consequences for young subjects. Some observational studies of humans who were exposed to anesthesia drugs at a very young age also report correlations with behavioral and neurodevelopmental issues. The questions raised in these studies are deeply troubling: are children who require anesthesia at a young age at risk of lifelong neurological setbacks? This is a troubling price to pay for safe and painless medical interventions in a highly vulnerable population.
A groundbreaking study released recently from researchers at the Mayo clinic shows results that should be encouraging for patients, their families, and the anesthesiologists who care for them. Dr. David Warner led a team of researchers in evaluating Minnesotan children via the Mayo Anesthesia Safety in Kids (MASK) study. The basic question this study aimed to answer was: do children who require multiple procedures facilitated by general anesthesia have a higher risk of adverse neurodevelopmental outcomes?
Much to the relief of researchers and clinicians alike, this rigorous cohort study suggests that the answer is no. The study mainly tracked children for differences in IQ, a useful barometer for adverse neurological impact. Also, it used screening and parental reporting to identify any behavioral or learning-related issues. This provided a holistic picture of many possible risks to the mental well-being of children who receive anesthesia before the age of 3. Results indicated that children with such exposure to anesthesia were not associated with lower IQs compared to children who had no anesthesia before age 3. With regard to the behavioral and learning issues, children with a single anesthesia experience also had no increased risk. However, children with multiple anesthesia experiences had slightly more reported learning and reading difficulties from parent accounts.
In studies like these, it is always difficult to know for certain whether potentially confounding factors have been appropriately accounted for. On a basic level, children who require medical interventions multiple times at a very young age likely have other differences from children who do not beyond their anesthesia exposure. It is nearly impossible to say whether the anesthesia are the determinant of the slight delay in reading, for example, or whether it is on account of an early childhood disrupted by medical challenges.
This research could have useful implications for hospital and larger-scale policies. Follow-up and coordination of services for medically complex children is an enormous area for growth and development. Medical science is ensuring the survival and thriving of more and more children with complex medical conditions that emerge at birth or early childhood. However, this population has particular needs and vulnerabilities that our health system should tend to in a serious manner. Ensuring their basic safety in using the necessary drugs to give them access to crucial surgeries and procedures is an important first step in their lifelong well-being. It’s also important to attend to any potential behavioral and cognitive challenges that children may face—if anesthesia drugs are not predisposing children to these outcomes, we may consider looking to other potential causes. One of the causes may be that parents of children with medical needs are lacking necessary supports in meeting learning benchmarks in the midst of their higher-stakes caregiving demands.
Warner, Zaccariello, Katusic, Schroeder, Hanson, Schulte, . . . Flick. (2018). Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study. Anesthesiology, -.