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Comments on Long Term Effects of Anesthesia
by Amy Beth Hilton, MD

Dear Folks,

Joanne asked me to talk about the effects of anesthesia (Joanne, I was going to chime in on this anyway, but thanks for thinking of me!) I have had many parents ask me about the possibility of long-term effects of anesthesia on their child's development. Based on what I know about the actions of all the drugs and gases used in anesthesia, there is no reason to think that having anesthesia, whether for a long or short time, frequently or rarely, would have any effect on the intellect or development of the child. Having said that, let me mention some situations where it might appear that the anesthesia had a longer lasting effect:

1)  Very rarely, (less than 1:50,000 anesthetics in kids, I would estimate), something will go wrong--the child's airway becomes obstructed, the child has a serious allergic reaction to a drug or latex gloves or other exposure, there is profuse blood loss during surgery, or other life-threatening event. These are _very_ rare occurrences, and because of the routine use of intensive monitoring in all patients, are usually detected early and treated before any harm can come to the child.  Sometimes, though, the brain may not get enough oxygen for a period of time. This could cause brain damage, which might be permanent. Even in those circumstances, kids are amazingly resilient and will often recover some or all of lost function over time.

2) Sometimes kids are psychologically traumatized by one or more aspects of the hospital experience, as hard as we try to help them through it. This can be a particular problem for kids who have multiple procedures. BTW, we always talk on this list about how many surgeries our kids have, and worry about how it will affect them. I anesthetize children for laser treatments of port wine stains (usually on the face, although we do have one child who is being treated for birthmarks on the chest and leg only). These kids get a treatment, which involves a 15 minute general anesthetic (much like we do for ear tubes) every six to eight weeks for years! They start anywhere from 6mos old to teenagers, depending on when the parent or child decide to pursue treatment. With the older kids, they and their parents usually were not aware that this treatment existed. They usually need a minimum of twenty treatments, but often require closer to fifty!  There are plenty of opportunities for these kids to get traumatized, and many of them do become fearful of the operating room and the anesthetic.  My point is (and, as Ellen DeGeneres would say, I do have one) these kids' behavior problems don't stop when they leave the hospital. They regress at home and at school, and some have poor school performance. It is difficult, if not impossible, to sort out what comes from the experience of multiple anesthetics, multiple trips to the hospital, and frequent pain, what comes from low self-esteem from being "different" and getting teased, and what is just normal behavior the child would have exhibited anyway.  It would be easy to say that the exposure to the anesthetic drugs is responsible for poor school performance or behavioral problems, but the fact is these drugs are out of the child's system in less than 24 hours, and many of these children do not have problems with behavior or school performance, in spite of the same number of anesthetics.  In any event, after any anesthetic, don't be surprised or worried if your child regresses for days to weeks. It is a normal reaction to any stressful event.

I hope I haven't made people more scared with these scenarios. I don't like to hear people talk about anesthesia like it is a necessary poison. Yes, there is risk involved. We try not to anesthetize anyone for longer than we have to, or unnecessarily, but the risk in a healthy patient is minimal. One could compare it to taking your child out for a drive in a reliable car, using a car seat. 

You could be hit by a drunk driver, or blow a tire and lose control of the car and be injured or killed. But that doesn't keep you from taking your child with you to the grocery store, even if you could leave her at home, or taking a scenic drive after your errands are done.  We accept risk of that magnitude every day, so why do we look at anesthesia any differently -- probably just because it's not an every-day sort of thing with which we are comfortably familiar.

Hope that was helpful,

Amy Beth

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