Category: Pediatric Anesthesia

Multiple Anesthetics Linked to ADHD

The Mayo clinic today published another chapter in the pediatric anesthesia story.  I have blogged about some of the initial studies that pointed to neurotoxcity here.  Dr Sprung et al published a paper entitled : ”Attention-Deficit/Hyperactivity Disorder After Early Exposure to Procedures Requiring General Anesthesia”

Abstract:

Objective
To study the association between exposure to procedures performed under general anesthesia before age 2 years and development of attention-deficit/hyperactivity disorder (ADHD).

Patients and Methods
Study patients included all children born between January 1, 1976, and December 31, 1982, in Rochester, MN, who remained in Rochester after age 5. Cases of ADHD diagnosed before age 19 years were identified by applying stringent research criteria. Cox proportional hazards regression assessed exposure to procedures requiring general anesthesia (none, 1, 2 or more) as a predictor of ADHD using a stratified analysis with strata based on a propensity score including comorbid health conditions.

Results
Among the 5357 children analyzed, 341 ADHD cases were identified (estimated cumulative incidence, 7.6%; 95% confidence interval [CI], 6.8%-8.4%). For children with no postnatal exposure to procedures requiring anesthesia before the age of 2 years, the cumulative incidence of ADHD at age 19 years was 7.3% (95% CI, 6.5%-8.1%). For single and 2 or more exposures, the estimates were 10.7% ( 95% CI, 6.8%-14.4%) and 17.9% ( 95% CI, 7.2%-27.4%), respectively. After adjusting for gestational age, sex, birth weight, and comorbid health conditions, exposure to multiple (hazard ratio, 1.95; 95% CI, 1.03-3.71), but not single (hazard ratio,1.18; 95% CI, 0.79-1.77), procedures requiring general anesthesia was associated with an increased risk for ADHD.

Conclusion
Children repeatedly exposed to procedures requiring general anesthesia before age 2 years are at increased risk for the later development of ADHD even after adjusting for comorbidities.

While time and smarter people than us will point out the flaws and confounding variables, it does seem like there is an emerging picture of neurotoxicity in repeat exposures to GA.

The popular press has a way of running with negative headlines when it comes to anesthesia.  Whether it is awareness under anesthesia, anesthesia providers gone bad, or weird side effects, the media is always ready to pounce.  This phenomena is most likely related to an underlying fear that the majority of their readers harbor and therefore buy more newspapers.  Our response, since the start of this blog, has been to cut through the BS and tell it like it is.  This mostly just succeeds in making ourselves feel better and not much else.  Some of the headlines related to this study:

 

Anesthesia before age 3 raises child’s ADHD risk
Children exposed to anesthesia multiple times are more likely to have disorder

-MSNBC

Could anesthesia cause ADHD in your child?

-FoxNews

General anesthesia in infancy linked to higher risk of ADHD

-CNN

Stay tuned for further developments.

Image: Salvatore Vuono / FreeDigitalPhotos.net

 

Feb 03, 2012 | 0 comments View Post

The End of Inhalation Induction…Redux


Flashy headlines aside, this contraption just made me laugh.  I was admittedly intrigued by the seemingly well thought-out design and the kid-friendly color palette but I can pretty much guarantee this won’t be my first choice in getting the kiddies to go nighty-night.  Check it out here.  Oh and negative points for the horrendous name.  

Apr 22, 2009 | 0 comments View Post

Pediatric Anesthesia Should Be Banned

Just kidding. But read on…

Many an interesting tidbit was produced from the ASA convention last week in Orlando. Nothing much worth blogging about but I did come across an interesting abstract that was picked up by the popular press

Newsweek writes:

“This week, Columbia University researchers presented a study at the annual
meeting of the American Society of Anesthesiologists showing a possible link
between exposure to anesthesia and behavioral and developmental disorders in
young children.”

This unpublished abstract is an unfortunate instance of exactly what is wrong with the popular press. First of all, in my humble opinion, nothing but either large double-blind randomized controlled trials or meta-analyses should EVER be reported on in the popular press…much less a piddly abstract. It’s a joke to even attempt to derive meaningful information from an unpublished abstract with many, many flaws. Not Columbia’s fault it was picked up, just bad reporting. Fear sells, I guess. But that’s just my opinion.

Now does this have any relevance to clinical practice and providing anesthesia to pediatrics? Much remains to be elucidated about the effects of anesthesia on the littlest patients of ours. There is an excellent editorial in this months Anesthesiology addressing this very issue here.  

I’m not ready to alter my practice at least not according to my evidence-based approach to things. Feel free to differ.

Oct 27, 2008 | 0 comments View Post

The end of inhalation induction?


As we all know, inhalation inductions should be a part of any anesthesia providers bag-o-tricks. Considering the alternative…sticking a hungry 3 year-old with a needle, i’d go with gas. Two alternatives on the market strive to make that painful iv start (or any needle stick) a thing of the past:
Zingo and Synera.

From the manufacturer’s website:

Zingo™ is indicated to provide topical, local analgesia to reduce the pain associated with peripheral IV insertions or blood draws, in children three to 18 years of age. Zingo is an easy-to-administer, single-use, needle-free system containing 0.5 mg sterile lidocaine powder. By using compressed gas to accelerate the lidocaine particles into the skin, Zingo provides a rapid onset of action, allowing intravenous line placement or venipuncture to begin one to three minutes after administration.


SYNERA topical patch has significant advantages for your patients. SYNERA, the topical analgesic [lidocaine/tetracaine mix] patch for superficial venous access procedures, approved for kids 3 years of age and older, has an onset of action in as little as 20 minutes, self-warming facilitates drug-delivery, peel and stick patch with bandage like appearance.

Not sure of costs at this time but they both seem like interesting alternatives. It seems the Zingo onset time has real advantages over the EMLA/bioocclusive method I currently employ. The twenty minutes required for Synera seems a bit too similar to what we already have. I also wonder how well-received the mini-explosion on the hungry three year-old’s arm would really be. Comments? Experiences?


Aug 09, 2008 | 1 comment View Post