After finishing my previous blog post: What happens to the brain under Anesthesia? It made me wonder what happens to young brains after anesthesiologists give anesthesia during a surgery. Does it affect their learning? Does it impair them? I decided to make my questions answers.

Background knowledge 

About 6 million American children – 1.5 million under the age of one – undergo general anesthesia each year. HealthDay reporter Tara Haelle wrote that having general anesthesia at a very young age might link to poorer brain development. She furthered the discussion by adding that children before the age of four who have received anesthesia during surgery later showed slightly lower scores on listening comprehension and parts on IQ tests compared to children who had never had general anesthesia the research found. Dr. Andreas Loepke, a professor of clinical anesthesia and pediatrics at the University of Cincinnati College of Medicine, said that, “It is difficult to see whether this decrease had any functional effect for an individual child. More research is needed to better understand the effects of anesthetics on brain development.”

The Study conducted

Dr. Loepke and his colleagues compared 53 children, healthy of a language development, at ages 5 to 18 who had undergone surgery using general anesthesia before they were 4 years of age with 53 children who had never been exposed to general anesthesia from five to 18 also. Each child from the first group matched to a child in the second group according to age, gender, socioeconomic status, and handedness (lefty or righty). All participants completed IQ and language development testing as well as imaging with an MRI that was appropriate for their ages.

The scores were all within the normal range for both groups, regardless of the surgical history. However, the children in the first group with history of surgery scored lower in listening comprehension and performance IQ about 3 to 6 points than children without surgery. The research team also found that those with a lower listening comprehension and performance IQ had slightly less gray matter in two areas at the back of their brains.

Dr. Loepke explained that, “Anesthetics exposure may interfere with normal brain development.” His findings suggested that general anesthesia in early childhood may be associated with long-term decline of language abilities and cognition. The causation remains unresolved and the findings still need additional research for the mechanism. He published his research online June 8, 2015 and in the July print issue of the journal Pediatrics.

Responses to Dr. Loepke’s Findings 

Just weeks after Dr. Andreas Loepke and his colleagues published their findings, the public had something to say about the results. Concerned parents and journalists wrote about the topic as to how they took the information at hand. One woman in particular wrote that it made it her more nervous to have her two little ones have to use general anesthesia from a minor procedure while the other might be getting an ear tube surgery.

Soon an expert doctor had something to say about Dr. Loepke’s results. Dr. Raafat Hannallah, a pediatric anesthesiologist as Children’s National Health System in Washington D.C., spoke on the results very carefully and had new things to bring up. He explained and I quote that, “the small study only shows a link between lower scores and a history of general anesthesia. It cannot show that anesthesia caused brain development problems. Studies in children have limitations that prevent experts from understanding whether the harmful effects, if any, were due to the anesthetic drugs or to other factors, such as the surgery or related illness.” This reassured the public and had Loepke and his colleagues have to write more information onto their work by mentioning that other factors, such as inflammation, pain, or the underlying medical problem treated could all occur during surgery. He also added for the concerned parents that skipping the surgery completely might lead to similar or worse concerns about brain development.

Study Analysis: My viewpoint

I found Dr. Loepke’s study was reasonable. The only thing I consider on making it better is making the study focused on one age group or a closer span in age group. Dr. Loepke’s study tested on ages from five to 18. I feel like the age window could have been closer and more accurate. He only tested on the children’s IQ and learning abilities. For one, I found here that brain fully develops at the age of 25. After reading this, it made me wonder why a scientist would study brains and their development before the brain is actually fully developed. Moreover, the topic, I found it too soon to judge on how one can study a 5-year-old brain development after a performed surgery a year ago. It would had made the results mean more if the patients were test before and or after to see if anything happened. You could never know if the child was already having developmental learning issues before the surgery if not studied beforehand. Furthermore, I agree with Dr. Raafat in that other factors, such as third variables, are considerable. Teens as young as 12 are smoking and drinking what provided or surrounded around them. Dr. Loepke did a study on the IQ and language development on the participants but never check to see the actual health and performance these teens are undergoing. Facts on drinking and smoking at a young age does have an effect on the developing brain. Dr. Loepke did not take this in account when selecting his participants so I doubt that these results are fully accurate because of the likelihood of it being due to a third confounding variable.

Summary

After all the research found on the topic, I realized that there is a link between young children’s brain and anesthesia effects. The correlation does not give enough evidence for us to believe that it is the causation because of confounding third variables both Dr. Loepke and Dr. Raafat have stated. It makes it difficult to point out what exactly the mechanism is in these cases after knowing that these are present. Like mentioned in class about medicine given by doctors, Loepke says that, “Surgery is only preformed to save lives or to prevent serious health complications.” This lets us know that, yes, there are down sides and negative effects to surgery, but in all, it is there to help. They do not perform the surgery to harm. Loepke adds that, “not performing these surgeries may put the child at a greater risk for developmental complications than the theoretical risk linked to the anesthetic exposure.” In the end, you have the choice in what is better for your child. I find that there is nothing to lose when in both cases there is chance for negative outcomes.