Anesthesia Is Safe in the Young: PANDA study

New York : A single exposure to general anesthesia poses no cognitive risk to healthy children under age 3, a critical time in brain development, according to a multicenter study led by researchers at Columbia University Medical Center and New York Presbyterian/Morgan Stanley Children’s Hospital. Findings from the PANDA (Pediatric Anesthesia Neurodevelopment Assessment) study, the largest and most comprehensive of its kind, were published in the Journal of the American Medical Association.

“A number of animal studies have suggested that exposure to commonly used anesthetic agents in early development could lead to deficits in learning, memory, attention, and other cognitive functions,” says lead author Lena S. Sun, MD, the Emanuel M. Papper Professor of Pediatric Anesthesiology and professor of pediatrics at Columbia and chief of pediatric anesthesiology at NewYork-Presbyterian/Morgan Stanley Children’s Hospital. “However, few clinical studies have adequately addressed whether this is also true in humans. Based on our findings, we can reassure parents that one exposure to anesthesia is safe for healthy young children.”

“The potential neurotoxicity of anesthetic agents commonly used in general anesthesia has been one of the most pressing concerns in pediatric surgery in the past decade. The PANDA project is among the most rigorously designed studies aimed at addressing this concern. Our findings should be reassuring to millions of parents whose young children need to undergo surgical procedures under general anesthesia across the world each year,” said Guohua Li, Dr PH, MD, the Mieczyslaw Finster Professor of Anesthesiology at the College of Physicians and Surgeons, professor of epidemiology at the Mailman School of Public Health, and a co-author of the paper.

An estimated 2 million children in the United States undergo anesthesia each year, roughly two-thirds for surgical procedures such as hernia repair, circumcision, and tonsillectomy. Anesthesia is also often used in diagnostic procedures, including imaging studies and endoscopies.

The PANDA study examined whether exposure to a single anesthetic of short duration (median of 80 minutes) in children under age 3 had an effect on global cognitive function (IQ) later in life.

The study included 105 healthy children who underwent surgical repair of inguinal hernia one of the most common operations of early childhood at one of four sites.

IQ scores and secondary neurodevelopmental outcomes, including memory, learning, processing speed, visuospatial function, attention, executive function, language, and behavior, were assessed when the children were between the ages of 8 and 15, allowing enough time after exposure to anesthesia for any impairments to emerge. Outcomes for each child were compared with those of a healthy, biologically related sibling of a similar age who was not exposed to anesthesia.

“There was no significant difference in IQ scores between the children who were exposed to anesthesia and siblings who were not,” says Dr. Sun. “We also saw no difference in most of the secondary outcomes, although more children in the group exposed to anesthesia exhibited internalizing behavior that required further clinical evaluation. That’s an area that needs to be further explored.”

Internalizing behaviors are behaviors that are directed inward. Examples of negative or problematic internalizing behaviors include anxiety, social withdrawal, and feelings of loneliness and guilt.

“Overall, this is good news for parents whose children need anesthesia for elective surgery or a diagnostic procedure,” said Dr. Sun.

“But the PANDA study leaves some important questions unanswered,” she adds. “We need to take a closer look at the effect of anesthesia on cognitive function in girls, since most of the subjects in the group exposed to anesthesia were boys. Also, we need to look at the effects of repeated and prolonged exposure to anesthesia, as well as the effects of anesthesia on more vulnerable subgroups, such as children with serious medical conditions.”

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Francis X. McGowan, MD et al. Association Between A Single General Anesthetic Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. JAMA, June 2016 DOI:10.1001/jama.2016.6967