"Will children become stupider after surgery under general anesthesia"? Don't be misled again!

As an anesthesiologist, I may often encounter parents asking the same question: "Will my child become stupid after surgery under general anesthesia?" Parents all over the world are worried about their children's health. Next, we will use popular language to interpret the latest scientific evidence and clinical practice results, and uncover the truth about general anesthesia for children, in order to dispel the concerns of all parents, relatives and friends who are worried about this.

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1. Parents’ concerns: Why do we have such doubts?

Misunderstanding the effects of general anesthesia: Parents may mistakenly believe that general anesthesia is a “forced shutdown” and worry that the drug will damage their child’s developing brain.

Misleading online information: Some out-of-context articles mention the effects of anesthetics on brain cells in animal experiments, but these conclusions are not directly applicable to humans.

2. Animal experiments ≠ human reality

Dosage difference: The dose of anesthetic used in animal experiments is much higher than that used in actual surgery.

Ignoring surgical effects: Animal experiments usually only involve anesthesia, while factors such as pain and inflammation in real surgery are not taken into account.

Brain repair ability: The brain compensation ability of human children is much higher than that of experimental animals.

3. Human studies provide key conclusions

Single short-term general anesthesia is very safe: Studies have shown that a single general anesthesia surgery of less than 1 hour has almost no effect on children's intelligence, memory, etc. [1].

Multiple/long-term anesthesia requires attention: more than three general anesthesia sessions or a single surgery lasting more than three hours before the age of three may have a slight impact on the child's attention after school, but this difference is within the normal range [2].

Special circumstances require special treatment: Premature infants or children with brain disease may require more cautious anesthetic protocols [3].

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4. How do anesthesiologists protect children?

Precisely control drug dosage: calculate the minimum effective dose based on body weight and age, and monitor brain waves in real time during surgery.

Choose safer drugs: Use newer anesthetics that are metabolized more quickly, such as sevoflurane[4].

Multimodal analgesia: Combined use of local anesthetics and analgesics to reduce the total dosage of general anesthetics.

5. Advice for parents

Don’t delay surgery when it’s necessary: ​​timely surgery carries fewer risks than delayed treatment.

Tell your doctor truthfully: provide your child's detailed medical history, including whether the child was born prematurely and whether he or she has any neurological diseases.

Postoperative observation + scientific parenting: Short-term unresponsiveness after surgery is usually a sign of incomplete drug metabolism, and recovery can be achieved in 1-2 days. Accompanying children to read and exercise more often is more helpful for their intellectual development.

6. Conclusion: Look at it rationally and make scientific choices

A single short-term general anesthesia does not affect intelligence.

There may be slight risks from multiple/long periods of anesthesia, but these are far less than the harm of leaving the disease untreated.

Don't refuse necessary surgery because you are afraid of anesthesia.

Modern anesthesia technology is very mature, and anesthesiologists will take multiple protective measures to ensure the safety of children. Parents should look at anesthesia risks rationally and choose treatment plans scientifically.

References

1. McCann ME, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomized controlled trial. The Lancet. 2019;393(10172):664-677.

2. Warner DO, et al. Neuropsychological and Behavioral Outcomes after Exposure to General Anesthesia in Early Childhood. JAMA Pediatrics. 2021;175(2):e205786.

3. Davidson AJ. Anesthesia and Neurotoxicity: What the Human Data Say. Anesthesiology. 2023;138(3):333-335.

4.. Guidelines for the safe use of anesthesia in children (updated in 2023)

Source: Chongqing Science Writers Association

Author: Wang Wei, attending physician of the Department of Anesthesiology, Bishan Hospital Affiliated to Chongqing Medical University, and Zou Jingbo, chief technician of Mr. Zou's Science Garden

Audit expert: Li Hanbin

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