This content is adapted from the APAGBI statement, April 2017
What should I say to the parents or carers of a young infant who express concern about anesthesia and the potential for long-term effects on the brain?
This should prompt an open and frank discussion. The central points to explain are:
- That the surgery or procedure is only being scheduled because it is necessary.
- The experimental data and measures used in animals cannot be directly translated into serious long-term effects in human infants.
- That there are currently no data to indicate that a single anesthetic of short duration causes long-term changes in cognitive development.
- The importance of careful management of pediatric anesthesia by trained personnel within a safe environment needs to be emphasized.
- That all babies and children are closely monitored during anesthesia and surgery to maximize safety and minimize side-effects.
- That surgery cannot be safely performed without adequate anesthesia and analgesia.
If parents still remain unsure or are concerned about providing consent for anesthesia and surgery, what should I do?
In the rare case when parents or carers remain sufficiently concerned to withhold consent for elective procedures, it may be necessary to organize a further discussion with all the relevant disciplines, to discuss the benefits of the procedure/surgery and risks of delay. This may result in postponement for cases that are not urgent.
Emergency or urgent surgery may still need to take place, and risks associated with delay clearly outweigh the theoretical issues about anesthesia on long-term cognitive development.
If I am called to anesthetize a young infant should I instigate a discussion about long-term effects of anesthesia on cognitive development?
No. It is important to discuss all the known risks of anesthesia in the pre-surgical discussion. Based on the current data discussions of effects of anesthesia on cognitive development is not necessary or mandatory.
Should I alter my current anesthesia practice in response to the current evidence base information or other published statements?
No. There is currently no evidence to support one particular anesthetic technique or drug regimen that has benefit over another in terms of reducing the potential effects of anesthesia on the infant brain. In addition, changing anesthesia practice from a familiar to an unfamiliar technique can itself introduce risk.
Is repeated exposure or long duration exposure to anesthetic agents more harmful than short-duration single exposure?
Current data on multiple exposures or longer-term exposures are unsuitable to answer this question at this time and unlikely to be resolved in the future. Evidence from both epidemiological and prospective studies indicates that a single exposure to anesthesia of an hour is safe in terms of cognitive development. The epidemiological studies carried out so far have not shown major adverse effects on the infant brain that can be specifically related to anesthesia. Infants who need multiple anesthetics or those who require complex surgery and anesthesia of long duration usually have additional comorbidities that can affect development.
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