Is Anesthesia Safe for Children?

Expert explains the research, offers tips

If your child needs surgery, you may be worried about anesthesia. You’re not alone.

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“Anesthesiologists know that many parents are concerned about anesthesia and its long-term effects,” says anesthesiologist Julie Niezgoda, MD.

These concerns stem from animal studies showing that anesthesia can cause the death of brain cells. But the findings in animals do not necessarily translate well to human babies for three reasons:

  1. The animals were exposed to high doses of anesthetics for long periods, which never happens to children.
  2. The animals did not actually have surgery, so they did not have any surgical stress (more on that later).
  3. Brain development is different in human infants than in animals, because growth in different regions of the brain varies.

Human studies ease concerns

Fortunately, several studies of children who have had one exposure to anesthesia suggest that “anesthesia is very safe and that children’s long-term cognitive development is unaffected,” says Dr. Niezgoda.

One large study of 2,500 ninth graders found no significant difference in educational outcomes between students exposed to a single anesthetic for hernia repair and age-matched students never exposed to an anesthetic. Another study compared twins having a single anesthetic to twins never exposed to an anesthetic and found no relationship between anesthesia and cognitive performance (learning ability).

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Studies continue to look at the long-term impact of single and multiple exposures to anesthesia on children, she says. The tests are still being refined and will not yield results for years.

A caveat about timing

“Based on the available data, it would be inappropriate to deny or delay surgery that a child needs for fear of unknown consequences,” says Dr. Niezgoda. “But if surgery is not essential during the first year of life, when a child’s brain is growing significantly, then parents may consider delaying it until later.”

If you have any concerns about the timing of your child’s procedure, talk them over with your surgeon.

Minimal exposure, maximal comfort

When surgery is done, pediatric anesthesiologists use the smallest amount of anesthesia that can effectively control pain. “We often use techniques to block pain only in the area of surgery,” says Dr. Niezgoda. “This exposes the child to less anesthesia overall.”

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Yes, it’s important to minimize children’s exposure to anesthesia — but it’s critical to control their pain. Otherwise, children can experience early and long-term problems from the “stress response” to surgery.

Surgery not only affects tissue at the site of the operation. “It also causes an increase in hormones and chemicals throughout the body,” says Dr. Niezgoda. “These chemical changes are called the stress response, and they can have significant effects on recovery. After surgery, a child’s heart rate, blood pressure, pain scores and inflammatory/immune system can undergo change as a result of the stress response.”

Tips for parents about children’s anesthesia

Anesthesia is geared to a child’s age and developmental stage. Dr. Niezgoda advises parents to discuss their child’s needs with the anesthesia provider before surgery. A few simple examples:

  • Mention thumb-sucking. If your toddler sucks his or her thumb, the anesthesiologist can often place the IV in the foot instead of the hand to provide comfort — and remove one source of irritation.
  • Address fear of needles. Most kids who are afraid of needles can fall asleep under a mask before the IV is inserted (unless they have a medical condition that won’t allow it, such as gastric reflux, or airway or stomach problems). For older children, an anesthetic cream will be applied to numb the hand first.
  • Reassure kids about pain control. “Encourage all children to ask questions about anything they are concerned about — pain control or other issues,” Dr. Niezgoda stresses. Teens may worry about waking up during surgery. Tell them that anesthesiologists will constantly monitor them to ensure that they stay asleep and pain-free. Let kids and teens know the healthcare team welcomes any questions — at any time.