Background: Millions of children each year require general anesthesia (GA), however, the safety of these medications on neurodevelopment is largely unknown. There is now a large body of evidence regarding anesthesia-related... [ view full abstract ]
Background: Millions of children each year require general anesthesia (GA), however, the safety of these medications on neurodevelopment is largely unknown. There is now a large body of evidence regarding anesthesia-related neurotoxicity established in animal models, raising concerns regarding translation into humans1. Clinical investigations into the potential neurotoxic effects of anesthesia in young children are growing2,3. Recently, federal organizations like the FDA have weighed in on the debate, releasing public warnings about anesthetics and sedatives in young children. Despite these warnings, at our institution, we have noticed a continued large number of infants undergoing elective surgical procedures. We sought to develop an educational curriculum for pediatric surgeons and proceduralists to better inform them about the potential neurotoxic effects of anesthesia.
Methods: We followed Kern’s six-step approach to curriculum development in implementing our educational initiative. A needs assessment in the form of an electronic survey was sent to all pediatric surgeons and proceduralists who regularly request GA, as well as nurse practitioners in the pre-surgical preparation clinic (Prepare). Goals and objectives for the educational intervention were then developed. We created an educational presentation summarizing current neurotoxicity evidence for distribution amongst these pediatric providers; it was presented at a multidisciplinary pediatric conference and distributed electronically as a video, accompanied by a brief written summary. Additionally, an informational pamphlet for parents was produced for dispersal in the providers’ offices and in Prepare. A post-educational intervention survey is pending. Electronic medical record review will be used to quantify the number of elective surgical cases performed in children under age one, over a six-month period, before and after the educational intervention.
Results: All 29 of the electronic survey respondents reported anesthetic neurotoxicity was concerning. Nearly all (93%) identified this topic as a knowledge gap, and only 18% knew of resources available for parents. Medical record review six months prior to intervention revealed 35 elective cases performed in children less than one year of age; the majority (22) were urological procedures such as circumcisions. Post-intervention data will be available starting late March 2017. We hypothesize there will be fewer elective cases performed for children under the age of one, post-educational intervention.
Conclusions: Written and video presentations summarizing current data on anesthetic neurotoxicity may be useful in educating pediatric providers requesting GA for elective surgeries in young children. We hope the materials from this study provide an organized framework for perioperative providers to approach discussions with patients and families about potential risks of anesthesia on the developing brain.
References:
- Disma et al. A systematic review of methodology applied during preclinical anesthetic neurotoxicity studies: important issues and lessons relevant to the design of future clinical research. Pediatric Anesthesia. 2016; 26: 6-36.
- Sun et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later outcomes. JAMA. 2016; 315(21): 2312-2320.
- Davidson et al. Neurodevelopmental outcome at 2 years of age after general anesthesia and awake-regional anesthesia in infancy (GAS): an international, multicenter, randomized controlled trial. The Lancet. 2016; 387: 240-250.
