Sedation and Anaesthesia Safety
Anaesthesia and Children: Brain Development
Anaesthesia and Children: The Data
The Animal Data
The initial research that sparked the concern about anaesthesia and children was related to fetal alcohol syndrome. Further study into rodents and non-human primates showed that prolonged and multiple exposures to sedation and anaesthesia drugs caused apoptosis in developing brains. Apoptosis is a programmed cell death that occurs when cells are injured.
There were three major concerns that arose from the animal research:
- What drugs or medications cause the programmed death of brain cells to occur?
- Would this also occur in humans?
- If it did occur in humans, would it cause any long-term side effects?
Animal research has shown that nearly all drugs that provide depression of the brain causing sedation or anaesthesia cause apoptosis of neural cells.
The major concern is that this includes all the medications capable of producing general anaesthesia and sedation, including laughing gas that is commonly used at dental appointments.
The Human Data
There are several major studies that have looked into the effects of sedation and anaesthesia on children.
General Anaesthesia vs Spinal Anaesthesia (GAS Study)
The GAS study is an international randomized double-blinded clinical study. It compared infants having hernia repair under general anaesthesia vs those infants having hernia repair under spinal anaesthesia. Spinal anaesthesia is the use of a local anaesthetic in the spine to block feeling, much like a dentist uses local anaesthesia to “freeze” the nerve or block feeling to the mouth. In this study, researchers assessed cognitive development at 2 years of age. The study found that the cognitive development of children having general anaesthesia was the same as those that had only spinal anaesthesia.
Pediatric Anaesthesia & NeuroDevelopment Assessment (PANDA Study)
The PANDA study looked at sibling pairs, one of which had general anaesthesia before the age of 36 months and one that did not. The researchers followed and tested each of the sibling pairs learning and cognitive abilities. The PANDA study found no difference in the brain development between young children having anaesthesia and those that did not. The use of sibling matched pairs helps to eliminate interfering factors with cognitive scores such as genetics, parenting, and environmental factors.
The Mayo Anaesthesia Safety in Kids (MASK Study)
The MASK study is the most recent and highly anticipated clinical study. The results were released on April 19, 2018. Nine hundred and ninety-seven children completed the IQ and cognitive testing. They divided the children into groups of those not exposed to anaesthesia, exposed a single time, and exposed multiple times. The MASK study found that there was no difference in IQ and cognitive testing scores between any of the three groups.
Anaesthesia and Children: Is it safe?
In recent years, media reports of patients suffering severe complications, including death, while under sedation and general anaesthesia for dental treatment may have raised concerns about the risk involved in these procedures. A new study by researchers at the University of Toronto (U of T), due to be published in the fall (2018), aimed to estimate the risk. The study examined mortality and morbidity reports associated with dentistry under deep sedation or general anaesthesia in Ontario dental offices. The overall finding of the study, explains Dr. Alia El-Mowafy, dental anaesthesiologist and the principal investigator of the research team, is that dentistry under deep sedation and general anaesthesia in the office-based environment has an excellent safety record.
“The results of our study show that the prevalence of death is 0.8 per 1 million patient encounters, and the serious morbidity rate is 0.25 per 1 million cases. In comparison, previous data shows that the likelihood of dying from a motor vehicle crash is 1 in 113, and the odds of dying from being struck by lightning are 1 in 174,000. Patients should know that the risk of anything catastrophic happening is really very low, and healthy patients who have deep sedation or general anaesthesia in the dental office seem to be at no more risk than they would be in a hospital.”