October 26, 2017

Groups of Paediatric Patients Undergoing Lengthy Anaesthesia

By Mike Bassett

BOSTON -- October 26, 2017 -- Infants under the age of 1 year, children 13 years and older, paediatric patients with high ASA physical status, and those treated in university hospitals may be at increased risk for longer exposure to general anaesthesia, which appears to affect neurodevelopment, according to results of a retrospective cohort analysis presented at the 2017 Annual Meeting of the American Society of Anesthesiologists (ASA).

In a poster presented here on October 21, lead author Devan Darby Bartels, MD, Massachusetts General Hospital, Boston, Massachusetts, and colleagues estimated the duration of exposure based on 1,548,021 paediatric general-anaesthesia datapoints from the National Anesthesia Clinical Outcomes Registry (2010 through 2015).

The average median general anaesthetic duration was 57 minutes. Children under the age of 1 year had the longest median exposure duration (79 minutes), and 13.7% of this cohort was exposed for greater than 3 hours. High ASA physical status, as well as care at university hospitals, were associated with longer general anaesthetic exposure times.

The vast majority of children (>94%) undergoing general anaesthesia, however, are exposed for less than 3 hours, Dr. Bartels and her colleagues observed.

“These findings may help guide the design of future trials aimed at understanding the neurodevelopmental impact of prolonged general-anaesthetic exposure in high-risk groups,” Dr. Bartels noted.

The US Food & Drug Administration (FDA) recently issued a warning about the potential neurodevelopmental effect that the lengthy use of general anaesthetic or sedation drugs could have on young children, particularly during surgeries and procedures lasting longer than 3 hours or during multiple procedures in children less than 3 years of age.

The ASA responded to the FDA warning by noting that potential risk of negative cognitive or behavioural effects of anaesthetic agents “remains uncertain, and must be placed in the context of the known risk and benefits of both the anaesthetic and the related surgical or diagnostic procedure for which the anaesthetic is required.”

[Presentation title: Estimating Pediatric General Anesthesia Exposure. Abstract #: A1256]

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