Children exposed to general anaesthestic have poorer development, literacy and numeracy scores

Study finds that children exposed to general anesthesia before 4 years have poorer development at school entry and school performance | Pediatric Anesthesia | via Journal of Anaesthesia Practice

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The new finding is based on a data-linkage study of over 210,000 children in New South Wales, Australia.

211,978 children included in the study were born in New South Wales at 37-plus weeks’ gestation without major congenital anomalies or neurodevelopmental disability. Of these, researchers had data on their school entry developmental assessment in 2009, 2012, or their Grade-3 school test results in 2008-2014.

The researchers compared the development and school results of children exposed to general anaesthesia during hospital procedures (37,880) up to 48 months of age to same-aged children with no exposure to general anaesthesia or hospitalisation (197,301).

Key findings

Compared to children unexposed to general anaesthesia, those exposed to general anaesthesia had a:

  • 17 per cent increased risk of poor child development
  • 34 per cent increased risk of lower numeracy scores on school tests
  • 23 per cent increased risk of lower reading scores on school tests

When the researchers restricted their analyses to children who’d had only one hospitalisation involving a procedure requiring general anaesthesia, they found no increased risk for poor development or reduced reading scores, however the risk of poor numeracy scores remained.

Full story at Journal of Anaesthesia Practice

Journal reference: Francisco J Schneuer, et al. The impact of general anesthesia on child development and school performance: a population-based study |  Pediatric Anesthesia |  2018; DOI: 10.1111/pan.13390

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The effect of general anaesthesia on the developing brain

The head of the CU School of Medicine Department of Anesthesiology in Colorado, has written a review of scientific studies on the potentially adverse effects of exposing developing brains to general anaesthesia | Anesthesiology

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Abstract

Recently, the U.S. Food and Drug Administration issued an official warning to all practicing physicians regarding potentially detrimental behavioral and cognitive sequelae of an early exposure to general anesthesia during in utero and in early postnatal life.

The U.S. Food and Drug Administration concern is focused on children younger than three years of age who are exposed to clinically used general anesthetics and sedatives for three hours or longer.

Although human evidence is limited and controversial, a large body of scientific evidence gathered from several mammalian species demonstrates that there is a potential foundation for concern. Considering this new development in public awareness, this review focuses on nonhuman primates because their brain development is the closest to humans in terms of not only timing and duration, but in terms of complexity as well.

Full reference: Jevtovic-Todorovic, V | Exposure of Developing Brain to General Anesthesia: What Is the Animal Evidence? | Anesthesiology | Published ahead of print Dec 2017

Medication Errors in Pediatric Anesthesia

A Report From the Wake Up Safe Quality Improvement Initiative | Anesthesia & Analgesia

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Background: Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies.

Conclusions: Our findings characterize the most common types of medication errors in pediatric anesthesia practice and provide guidance on future preventative strategies. Many of these errors will be almost entirely preventable with the use of prefilled medication syringes to avoid accidental ampule swap, bar-coding at the point of medication administration to prevent syringe swap and to confirm the proper dose, and 2-person checking of medication infusions for accuracy.

Full reference: Lobaugh, L. et al. (2017) Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative. Anesthesia & Analgesia. Vol. 125 (Issue 3) pp. 936–942

Movies could replace anaesthetic for child radiotherapy

Children with cancer could be spared dozens of doses of general anaesthesia by projecting a video directly on to the inside of a radiotherapy machine during treatment | OnMedica

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The new research was presented this week at the ESTRO 36 conference (European Society for Radiotherapy & Oncology), taking place in Vienna, Austria.

Catia Aguas, a radiation therapist and dosimetrist at the Cliniques Universitaires Saint Luc, Brussels, Belgium, told the conference that using video instead of general anaesthesia is less traumatic for children and their families, as well as making each treatment quicker and more cost effective.

The study included 12 children aged between one and a half and six years old who were treated with radiotherapy using a Tomotherapy® treatment unit at the university hospital. Six were treated before a video projector was installed in 2014 and six were treated after.

Before the video was available, general anaesthesia was needed for 83% of children’s treatments. Once the projector was installed, anaesthesia was only needed in 33% of treatments.

Read the full commentary here

Using Technology to Reduce Childrens’ Anxiety Throughout the Perioperative Period

Goldschmidt, K. & Woolley, A. Journal of Pediatric Nursing | Published online: 27 April 2017

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In the U.S. each year, approximately 5 million children undergo a surgical procedure (Perry, Hooper, & Masiongale, 2012). Surgery is one of the most stressful medical procedures that a child can experience. In fact, approximately 50% of children are reported to experience significant anxiety in the preoperative period (Perry et al., 2012). Pediatric nurses know the importance of incorporating parents into the child’s plan of care and understand that the child is comforted by the presence of someone that they know and love.

Read the abstract here

Parents’ reactions can lessen or worsen pain for injured kids

New research (yet to be published) has looked at family coping and distress during a dressing change following a burn injury in kids | The Conversation

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The 18-month study observed 92 families during their young child’s (one to six years) first burn dressing change at a Brisbane hospital.

Parents who reported they were more anxious or distressed were less able to support their child during the procedure. This decreased the child’s ability to cope and increased the child’s distress, which was measured by their ability to be distracted by toys and conversation, compared to crying or screaming during the dressing change.

Ratings of child anxiety and pain during the dressing change were also greater for children of parents who were less able to support their child during the dressing change.

Read the full blog post by  Erin Brown & Justin Kenardy here

Low Back Pain in Children and Adolescents

Moreno, M. (2017) JAMA Pediatrics. 171(3):312

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Image source: H – – J – Flickr // CC BY-NC-ND 2.0

Low back pain is often thought of as an adult condition. However, it is relatively common as children grow older.

At 7 years of age, about 1% of children will have experienced low back pain; at 10 years of age, about 6% of children will have experienced low back pain; and at 14 to 16 years of age, about 18% of adolescents will have experienced low back pain.

Unfortunately, having low back pain as a child or adolescent is a significant risk factor for having low back pain as an adult.

Read the full article here