Most doctors choose not to give babies painkillers for surgery. The reason may be that some practitioners refuse to believe that babies feel pain, or that the effects of administering general anesthesia in youngsters is still relatively inconclusive.
Now, the largest study ever to examine the impacts of general anesthesia (GA) in babies has established that an hour of GA during surgery is no more damaging to infant brains than local anesthesia (LA) given at two years of age.
However, the jury is still out as the longer-term effects of GA to some aspects of babies' neurodevelopment cannot be examined at such a young age.
Meanwhile, although there is a growing body of research that shows the negative effects of anesthesia on the brains of young monkeys and lab rats, the initial findings of the Melbourne-led study sent a wave of relief through the medical community worldwide.
Testing Babies' Mental Capacity
In this GAS study, researchers and practitioners at 28 hospitals in Australia, Canada, New Zealand, Europe, and the United States tested the cognition, language and motor skills of 722 infants who were randomized to receive either general or local anesthesia for hernia repair surgeries two years prior.
Experts compared the mental performance of infants who received less than an hour of GA against those who received a local or spinal anesthetic, which leaves babies still awake but numb and immobilized from the waist down.
Lead researcher Andrew Davidson, an associate professor at Murdoch Childrens Research Institute and senior staff anesthetist at Royal Children's Hospital, said their study revealed absolutely no difference between the two groups.
"We can't conclude they're both safe," said Davidson, who presented the findings at the Australian and New Zealand College of Anaesthetists annual meeting Sunday. "But there's no reason to think the spinal anaesthetic would be unsafe because all of the animal data shows that it is okay."
In fact, the study suggests that spinal anesthetic had safer short-term outcomes than general anesthesia, including fewer breathing complications during recovery, but at two years old, there was no difference.
Conflicting Findings
Davidson and his colleagues' findings were published in late 2015 in the journal Lancet and had come into conflict with studies that supposedly show how GA interferes in the way the brain develops in monkeys and worms.
In 2012, a study published in the journal Pediatrics had linked even a single dose of anesthesia to later harm in babies, including difficulty in language and learning problems. There is a caveat though: the 2012 study did not prove a cause-and-effect relationship, and it only provided an association.
Pediatric anesthesiologist Lena Sun, one of the researchers of the 2012 study, said they do not want to scare parents.
"If children need to have surgery, you need to weigh all the risks and all the benefits in terms of what you need to do," said Sun.
What's Next?
Davidson says the findings of their study provided a wave of relief for many anesthetists, especially as research in the past decade showed negative impacts.
Still, he warns that the findings were not conclusive. Another limitation is that it only covered an hour of surgery, which captures roughly half of surgeries that babies and toddlers usually undergo.
In the meantime, Davidson and his team are already beginning to retest the children in the study as they turn five years old. Named "T-Rex," the next trial will include 500 children who will be tested for surgeries that last at least three hours.
Photo : Bridget Coila | Flickr
