Is Anesthesia Safe For Children?

As the Chief of Anesthesiology at Texas Children’s Hospital, I am well aware of the raised public awareness about the possible effects of anesthesia on childhood neurological development. I believe it is important for all parents to understand the facts around this issue so that you can feel confident about entrusting your children to our care.

The question of anesthetic effect on neurodevelopment has been raised more and more frequently over the past few years. To answer this, two recent studies have been conducted, including one at our Texas Children’s Heart Center, to learn more about this issue. We found that the amount of anesthesia and sedation received in the perioperative period for congenital heart surgery in neonates DOES NOT affect neurological outcomes (based on testing at 12-24 months of age). Two additional studies are currently underway as well.

At Texas Children’s, over 32,000 patients undergo anesthesia and sedation every year. Our practice has been and always will be to treat each child as an individual, and to give that child the right anesthesia drugs and doses, to ensure safe and successful completion of the surgery.

Because children are so small, we have specially-trained staff dedicated to anesthetizing children — and significant complications are very rare. If you’re interested in learning more details, I encourage you to visit the Smart Tots website. You can also ask a question below and I will answer them as best I can.

Please know that nothing is more important to Texas Children’s Hospital than the safety and health of the children it is our privilege to treat every day. We also believe it is important to have an open and honest dialogue with our families and I hope this blog entry will help foster such a conversation.

About Dr. Dean B. Andropoulos, M.D., M.H.C.M., Anesthesiologist-in-Chief

I am the anesthesiologist-in-chief at Texas Children’s Hospital, and professor and vice chair of the Department of Anesthesiology at Baylor College of Medicine. I have authored over 70 publications and 30 book chapters, and I am the editor of two major textbooks on pediatric anesthesiology. I have held a number of national leadership positions, including as founding president of the Congenital Cardiac Anesthesia Society. My research is partly funded by the National Institutes of Health, and focuses on the effects of anesthesia and surgery on the developing central nervous system. I am proud to lead a department at the cutting edge of pediatric anesthesiology where patients are our focus.
Posted in Anesthesiology, Parenting, Surgery

20 Responses to Is Anesthesia Safe For Children?

  1. Jennifer Flinn says:

    Dr. Andropoulos,

    My daughter is 4 and has a white matter brain injury from prematurity. She has had to undergo anesthesia on 5 occasions since her birth. I am told that children metabolize anesthesia quite quickly and it does not stay in their system long after adminstration nor does it build up over time. Is this true? Could she be effected more based on her injury? I am told that radiation such as X-ray and MRI are more harmful over a lifespan then anesthesia. I also wonder if the more it is adminstered, the more likely a side-effect? I appreciate your time and was so happy to see your blog as this is such a hard thing for parents to put their children through.

    Jennifer Flinn

    • Dr. Dean B. Andropoulos, M.D., M.H.C.M., Anesthesiologist-in-Chief Dr. Dean Andropoulos, Chief of Anesthesiology says:

      Dear Ms. Flinn-

      These are excellent questions. Both the anesthesia gas, and any medications given by vein, are eliminated by the body in minutes or hours after anesthesia, so the medications do not build up over time. Premature infants do have this type of brain problem frequently; there is not any information telling us that anesthesia is more of a risk in these patients.

      What we do know is that many premature babies need anesthesia, often more than once, for surgery or other procedures that are very important to improve their overall health, so I would not be concerned about your baby needing several anesthetics. X-rays are of course needed often in premature infants, and are only done when physicians need important information about the baby. MRI is not an x-ray, but pictures made in a magnetic field, and babies may need sedation for this study to hold very still to get the best pictures. The anesthesia also is only done when absolutely necessary, and is very important to prevent pain from surgery.

  2. Autumn Selman says:

    Since you refer to the above mentioned studies, maybe you might forward me a copy to review. My son was treated for Tetralogy of Falot and does have some neurological issues. I was not advised of, referred to , or included in these studies. When seeking treatment for my son, i was told by Pat, Dr. Zeller’s assistant, to “go somewhere else” for treatment. Perhaps your studies may offer some insight.
    By the way, feel free to verify my statement in the patient advacocy logs if you wish.

    Autumn Selman

    • Dr. Dean B. Andropoulos, M.D., M.H.C.M., Anesthesiologist-in-Chief Dr. Dean Andropoulos, Chief of Anesthesiology says:

      Dear Ms. Selman:

      Recent studies over the past decade or so have shown us that some patients with congenital heart disease, including Tetralogy of Fallot, do have some neurodevelopmental issues. We now know that there is a wide variety of causes, and at times it is difficult to tell in an individual patient what exactly the reason is for any problems. Our own research, and that of others has shown us that sometimes the growth and development of the brain in infants with congenital heart disease is not normal, and that often this problem starts in utero because of the heart defect.

      This is not true for all babies. What our study did show is that the size of the doses of anesthetic and sedative agents in newborns undergoing open heart surgery did not affect their neurodevelopmental status at age 12 months. These studies have only been offered to newborns undergoing open heart surgery at TCH, and normally Tetralogy of Fallot patients are not treated this way. Some Tetralogy of Fallot patients also have chromosome changes that may cause neurodevelopmental problems.

      I would advise any parent of a child with congenital heart disease, or other complicated medical problem, in whom there is concern about neurodevelopment, to go to their pediatrician and request a formal evaluation by a team of experts. This is something we can certainly offer at TCH. Then, if there are problem areas identified, a specific treatment plan for the child can be recommended by these experts.

  3. Sara says:

    Dr. Andropoulos,

    Thank you for posting on this subject. We came across the FDA’s announcement of the Smart Tots panel as we were researching anesthesia risks. Our 6 month old daughter is scheduled to have a MAG-3 renal scan in two weeks and we were told that she would be put under anesthesia for the scan. She was diagnosed with mild to moderate unilateral hydronephrosis prenatally and her urologist ordered the MAG-3 scan in order to obtain a baseline kidney function.

    We are VERY concerned about her exposure to anesthesia, particularly because of the amount of time she will have to be under (45 minutes to an hour) and also because she will almost certainly have to have more than one scan over the next few years. My question for you relates to the type of anesthesia/sedation used on infants, particularly during scans and MRI procedures. The 2009 Mayo clinic study that linked anesthesia in infants and learning disabilities looked at Halothane and Nitrous Oxide. The Mayo clinic website states that although Halothane is not really being used any longer, current anesthetic drugs have a similar affect. I assume that would include Propofol, which is the drug that we were told was going to be used on our daughter. Have sedative drugs like Chlorolhydrate been studied for their affect on brain development? We are wondering if this might be a better option than Propofol for our daughter.

    (I’ve read that Chlorolhydrate and other sedatives aren’t used as much because they cannot be controlled like anesthesia and there is some risk that it wears off before the end of the procedure (particularly for the MAG-3). However, I read an article about a study done by St. Christopher’s Hospital that Chlorolhydrate IS effective on children under 48 months old.).

    Thank you for allowing me to post this concern and I look forward to your insight.

    Regards,
    Sara McMahon

    • Dr. Dean B. Andropoulos, M.D., M.H.C.M., Anesthesiologist-in-Chief Dr. Dean Andropoulos, Chief of Anesthesiology says:

      Dear Ms. McMahon:

      Thank you for the thoughtful question about these important issues. The renal scan is of course a very important test to determine kidney function so your daughter’s doctors can plan treatment to preserve kidney function as much as possible. To acquire the best possible images, the patient does have to be absolutely still for about 45 minutes. Infants and young children will require sedation for this.

      You are correct in that at TCH, propofol is normally used for sedation. Propofol works in a similar way to most of the other anesthetics, including all anesthetic gases, to produce anesthesia by binding to a certain type of receptor in the brain. Chloral hydrate and most other sedatives also work in a similar way, so none of the drugs used for sedation for a renal scan is very different. What I can say is that this is an important test, and because it is not really painful, a relatively small dose of propofol is normally needed, and your anesthesiologist will be highly skilled, and will give just the right dose of sedation for your daughter. He/she will monitor breathing, heart beat and blood pressure very carefully. The real advantage of propofol is that after the procedure is over, the medication is turned off, your baby will wake up quickly, and the drug rapidly eliminated from her body. Normally, patients are completely back to their normal selves in less than an hour, and are discharged home with a normal diet and activity shortly after.

      There is no evidence that a brief sedation has any effect on neurodevelopment and so I would not worry about having this test, which is so important for your daughter’s overall health. If she needs additional scans or other procedures, your anesthesiologist will carefully evaluate her current status at that time and choose an anesthetic plan that is best for her. Again, the most important point is that she needs these tests to plan the very best course of treatment for her kidney problem.

  4. Edward says:

    Dr. Andropoulos,

    I have a few questions:

    My son had ear tubes put in at 11 months due to ear infections (agents were nitrous oxide and sevoflurane). The entire procedure was completed in 15 minutes.When he was referred for surgery, he was evaluated by his pediatrician and seemed to be on track with milestones. He had already started saying “mama” for example. A few weeks after surgery, he stopped responding to his name, and became quite withdrawn (a few people thought he was deaf). He also didn’t learn to point until quite late, and he also lost the limited vocabulary he had developed at 18 months. The ear tubes had been examined by the ENT and by his pediatrician, and were found to be working perfectly, and his hearing was tested and found to be fine, post-procedure. Although he is catching up quickly at age 27 months (with some speech therapy), and he seems to be a bright child in other respects, we are quite worried that our decision to let him undergo the procedure could have altered his development, or could result in subtle life-long mental impairment.

    The obvious explanation for his delayed speech is the fluid he had in his ears as an infant, but there remains a nagging doubt that the speech delay could have been caused by anesthesia. Do you think that this is likely?

    He has also had the usual toddler bumps and bruises to his head, but he seems to recover quite slowly from these, forgetting some words on occasion – could anesthesia result in reduced recovery capacity from what would otherwise be “normal” head trauma in toddlers?

    At a follow up appointment with the ENT who did the surgery, he said that he was aware of the risk of developmental problems, but that if any risk existed, it affected children under the age of six months. Is this accurate?

    Our son has trouble breathing through his nose at night, but after reading about the possible development risks of multiple anesthesia exposures, we are not keen on taking him for an exam, in case he needs additional surgery on his adenoids and tonsils. Should we be wary of surgery?

    • Dr. Dean B. Andropoulos, M.D., M.H.C.M., Anesthesiologist-in-Chief Dr. Dean Andropoulos, Chief of Anesthesiology says:

      Dear Edward:

      These are common and important questions. There is no evidence that a brief exposure to anesthetic agents has any effect on neurodevelopment, including speech and language, so the anesthetic would not be the cause of the delay in any milestones. I am certainly pleased that he is catching up. If your son’s ENT surgeon believes that his breathing is impaired by enlarged adenoids or tonsils, and recommends surgery, then he should have the surgery and you should not be concerned that the anesthesia will have effects on his further development. These problems are common in young children, and if it is necessary to have the procedure done, the health benefits to your son of having the surgery far outweigh any risks of the anesthesia itself.

      Our anesthesiologists at TCH are specially trained and very experienced at providing anesthesia for these ENT procedures, and they evaluate each patient individually and decide on the best anesthetic for that child. So I would not be concerned if it is necessary to undergo another anesthetic for your son.

      • Edward says:

        In the interests of accuracy, I need to clarify and update my previous post from March.

        He did have a mild speech delay, although a lot of it may have been due to shyness in front of other people, who expressed concern, and magnified our own doubts as parents. Looking back, I don’t think his speech delay was hugely significant and we were comparing him to one particular, rather verbal child. Also he had a non-English speaking caregiver, and he was technically meeting his milestones on time, but not talking a lot.

        The “speech therapy” I mentioned was actually more evaluations, rather than active intervention from the therapist. My wife hadn’t explained it to me in detail at the time.

        He just turned 3, and talking quite a lot suddenly. He could name 12+ colours from 2.5 years and recognize and name all alphabets, shapes and numbers.

        We didn’t let him go for further surgeries. We avoided the ENT. Not worth the (as yet unquantified) risk. His breathing problem resolved itself.

        I still hope that this issue is resolved speedily for our peace of mind, and that of other parents.

  5. Holly Hubbard says:

    Dr. Andropoulos, My 9 year old son is a former preemie who had numerous surgeries when he was a baby. His only effect of prematurity is his vision. He has had numerous eye surgeries when he was small and due to that his eye doctor thinks it is best to check his vision under anesthesia. My concern is, is there such a thing as being under anesthesia too much? He has been “under” more than most in their lifetime and we want to make sure that being under anesthesia multiple times won’t hurt his body now or in the long run.

    • Dr. Dean B. Andropoulos, M.D., M.H.C.M., Anesthesiologist-in-Chief Dr. Dean Andropoulos, Chief of Anesthesiology says:

      Dear Ms. Hubbard —

      This is an important question. Many premature babies do need surgery, and must of course have anesthesia for the surgery. The eye surgeries, in particular, are very important to help his vision be the best it can when he is older. The possible concerns that anesthesiologists have about the effects of anesthesia seem to be most important in very young infants, at the time when the brain is growing and developing very fast. We believe that after age 2 to 3 years, when the growth of the brain is less, that any worries about anesthesia’s effects are less. And remember, we really do not know for sure yet if anesthesia has any adverse effects at all.

      The most important thing for you to know is that your son has done as well as he can, in large part because of the surgeries, and anesthesia he had as a small baby. If his eye doctor believes it is best to have your son under anesthesia for the best possible eye examination, I would not worry that he has had too many anesthetics. The benefit of having accurate, up to date information about your son’s vision far outweighs any possible small risk of the anesthesia. The eye exam is usually fairly brief, and the levels of anesthesia needed are not high.

      And, your son’s anesthesia at Texas Children’s Hospital will be given by our team of pediatric anesthesiologists, who design just the right anesthetic for each child, at the right dose. So, I would not be concerned that an anesthetic for your son’s eye exam will have any long term effects.

  6. Ayesha says:

    What about anesthesia in 2 months old? Small surgery to fix communicating hydrocele? Or shall we wait till my baby is 1 year old?

  7. Nick says:

    Hi Dr Andropoulos ti kanis? I have a few questions. My 7 month old son is scheduled for hypospadias surgery within the next month or so. I was wondering what you recommend as best age to do the surgery in terms of Anaesthesia and is there a specific weight or growth percentage he needs to achieve in terms of him being ready for the surgery? Also what is the most likely anaesthetic they will use for such an operation and are there any bad side effects? Thanks a lot!

  8. Pushpa says:

    Hi Doctor. My 2 month son is recovering from pneumonia, but last week doctors found that my son’s right lungs have been collapsed due to thick mucuous. Sir for past five days doctors are doing nebulisation and physiotheraphy but no improvement. Hence dey are going for broncoscopy and will use Anaesthesia for 20-25 mins. Doctor my son is a heart patient. He has ASD 6mm and VSD 8.5 mm for which we have to go for another surgery and again doctors will use Anaesthesia on my son. My concern is that such usage would cause any health problems to my son in future whether mentally of physically. Please advise Sir. Thank u

  9. Naema tashkandi says:

    My 3 years old grandson needs his teeth to be treated under anaesthesia , is it safe at his age ?

  10. Naema tashkandi says:

    My 3years old grand son needs to fix his teeth under anaesthesia I am concerned
    Is it safe?

  11. Ashok says:

    Hello Sir,
    My baby is 19 months old and he was diagnosed with myopia at the age of 8 months. He is using prescription glasses. Now for further examination he is not allowing doctor for eye examination. So, my doctor has decided to go for general anesthesia for proper eye examination.
    Are there any other alternatives other than anesthesia?
    Is anesthesia safe at this age?
    Thank you.

  12. vision support says:

    vision support having a proper way of taking care of our eyes, it wont be damaged.

  13. ariif sheikh says:

    My 9 month baybe is having problem of dermite sist into mouth.doctor recommend for surgery.gving anaesthesia

  14. Suju says:

    my 2year 1 month old baby will undergo circumcisionunder general anesthesia is it safe???

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