Anesthesia Exposure in Early Childhood Unlikely to Impact Brain Health

Blurred shot of little girl with oxygen mask lying on bed in operating room.
Article Summary
  • Dr. Daniel Armstrong co-led a study that showed repeated exposures to general anesthesia doesn’t change a child’s brain structure or function.
  • Dr. Armstrong used data taken from a previous study of young cystic fibrosis patients, some of whom were exposed to anesthesia for a common diagnostic procedure.
  • Dr. Armstrong and colleagues analyzed MRI images and neurocognitive measures and found no differences in brain structure and neurocognitive function amongst the children in the study.

Repeated general anesthesia exposure in young children does not result in changes in the brain’s structure or function, according to a study co-led by Daniel Armstrong, Ph.D., director of the Mailman Center for Child Development and professor of pediatrics and psychology at the University of Miami Miller School of Medicine.

The study was recently published in one of the world’s top medical journals, The Lancet Respiratory Medicine.

A trial compared babies with cystic fibrosis who received general anesthesia multiple times with children who received far less general anesthesia in the first five years of life. Dr. Armstrong and collaborators in Australia and New Zealand used the data to study the bigger-picture concern about long-term effects of recurrent general anesthesia on developing brain function.

“The need to answer this question had roots dating back to 2007,” Dr. Armstrong said. “I was part of the FDA Anesthetic and Life Support Drugs Advisory Committee that reviewed preclinical data that found structural changes and impaired memory and learning in mice, rats and guinea pigs following exposure to different general anesthetic medications.”

The report raised international concerns about giving children general anesthesia and national concern among pediatric anesthesiologists, surgeons and parents.

“Our study is the only randomized clinical trial of repeated general anesthesia—and probably the only one that can be done ethically—to address one of the major concerns that the FDA panel noted as unaddressed,” Dr. Armstrong said.

Dr. Armstrong and colleagues examined the issue of anesthesia safety using the Australasian Cystic Fibrosis Bronchoalveolar Lavage trial, in which researchers describe pulmonary outcomes of children diagnosed with cystic fibrosis. Researchers randomized about half of the children to receive repeated bronchoalveolar lavage, a common diagnostic procedure, at three months to six months of age. The other children received standard care, with no planned bronchoalveolar lavage procedure until they were at least 5 years old.

Dr. Daniel Armstrong in white clinic coat
Dr. Daniel Armstrong

Children in the bronchoalveolar lavage group received general anesthesia—usually sevoflurane—an average of 10 times prior to turning 5. The standard-of-care group received general anesthesia on average four times during that period.

“The trial’s hypothesis was that repeated bronchoalveolar lavage might improve lung function in children with cystic fibrosis. Researchers did not, however, find a difference between groups,” Dr. Armstrong said. “The trial made it possible to answer our pressing question about general anesthesia use in childhood.”

Years later, when children who completed the trial were an average of 12 years old, Dr. Armstrong and colleagues analyzed MRI images and neurocognitive measures between the two groups.

They found no differences in brain structure and neurocognitive function between the groups.

Dr. Armstrong led the study, called CF-GAIN, along with Claire Wainwright, M.D., a pediatric pulmonologist at the University of Queensland in Australia. Researchers included a team of pulmonologists, psychologists, radiologists, anesthesiologists and biostatisticians. The Australian National Health and Medical Research Council funded the research.

Tags: anesthesia, Dr. Daniel Armstrong, Mailman Center for Child Development, pediatrics