Anytime a child undergoes a surgical procedure requiring anesthesia or sedation, parents will have questions about possible risks—especially when that child is an infant or a toddler. In an effort to help families prepare, the American Academy of Pediatrics (AAP) answers frequently asked questions about the safety of anesthesia.
Q: Is anesthesia safe for my baby?
A: Anesthesia and sedation are safer than they have ever been. Pediatric anesthesiologists have made it possible for millions of children—even the sickest babies—to undergo lifesaving surgeries and life-enhancing procedures. Like any medicine, anesthetics have associated risks for every person—young and old. Scientists and physicians continue to look at the safety and side effects of all medicines that are used in infants and children.
Q: When infants or young children need surgery, does anesthesia affect their developing brains?
A: Scientists have been investigating the effects of anesthetics on the developing brain of animals for over 20 years. While animals who have long or repeated anesthesia may have problems with learning and behavior later in life, a single carefully administered anesthetic has not been found to be associated with these problems in children.
The U.S. Food and Drug Administration (FDA) and the International Anesthesia Research Society (IARS) started an initiative called SmartTots (Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots) to coordinate and fund research intended to make surgery, anesthesia, and sedation safer for infants and young children under age 4—a period of significant brain development. This research will help determine if any particular anesthetic or sedative drugs pose hazards to young children, design the safest anesthetic and sedative regimes, and potentially foster the development of new anesthetic and sedative drugs.
Over the past few decades, pediatric anesthesiologists have come a long way in ensuring the safety of young children under general anesthesia. There is much more to understand about the risks, and intensive research into all safety aspects of general anesthesia is ongoing now.
Q: What should I do if my baby requires surgery?
A: Parents should discuss all of the risks and benefits of their child's surgery or procedure with his or her pediatric specialists.
Ask about timing. If there is no risk associated with waiting to get the surgery (i.e., not life threatening or an emergency), then consider putting it off until your child is older than 3—research suggests that the effects of anesthesia on the brain decrease with age.
Talk to your anesthesiologist. If your hospital allows you to have a say in choosing an anesthesiologist, request the one who works on children the most frequently. Pediatric anesthesiologists are trained to use the least harmful medications to avoid problems and to tailor the amount of anesthetics given to the child based on his or her age, weight, gender, other medications being taken or specific illnesses.
Recognize that current anesthetics and/or sedatives are necessary for infants and children who require surgery or other painful and stressful procedures.
Q: How will the pediatric anesthesiologist keep my child safe?
A: Specially trained pediatric anesthesiologists will carefully administer medications to help your child go to sleep and stay safe and comfortable. Children react to anesthesia differently than adults. The pediatric anesthesiologist will monitor your child's heart rate, blood pressure, breathing and oxygen levels, and adjust medications as needed. He or she will do whatever is needed to keep your child's vital signs stable and free of pain.
Q: Are there any alternatives to general anesthesia for surgery?
A: In young children, the safest way to perform most surgeries is under general anesthesia. The medications used for sedation have the same side effects as general anesthetics and vary depending on a child's age, weight, developmental level, health history, physical exam, and the type of test being performed. For example, light sedation is not often appropriate or possible for infants and young children.
Q: Are any medications used for sedation or anesthesia safer than others?
A: All medications used for sedation or anesthesia have been shown to affect normal brain development in animals when given repeatedly or for long periods of time. Certain types of anesthetics, such as opioids, clonidine, and dexmedetomidine, may not have these same cognitive effects in animals. While these alternative anesthetics are promising, they're not appropriate for all patients or procedures. Fortunately, researchers are working hard to find new medication options.
Q: My 2-year-old requires an MRI scan. Can he have this done without any anesthesia?
A: Most young children cannot remain still for an MRI scan and require general anesthesia to help them relax or sleep during the procedure. Several factors are considered when determining if a child will need general anesthesia, including:
The age and developmental level of child—Infants and toddlers generally will not understand why they are having the MRI.
The length of time it takes to do the procedure—It can be 1-2 hours.
The amount of discomfort expected during the procedure—It is quite noisy and the child is moved into a narrow pipe and must remain motionless.
Q: My newborn has an intestinal blockage, and her doctors say she needs surgery. Will the anesthesia hurt her brain?
A: This surgery is considered an emergency. Waiting can lead to many more complications and can threaten the life of your child. Pediatric anesthesiologists are trained to provide the safest and most effective anesthesia possible for your baby. Young children rarely have an operation unless there's a serious medical problem that can't wait.
Q: My 1-year-old needs ear tubes for repeated ear infections. Should I wait until he is older to get this done?
A: Follow the advice of your pediatric otolaryngologist (ENT). Chronic ear infections can cause problems with hearing and speech, so it is important that they get treated properly. These procedures are short and associated with very little exposure to anesthesia. A single short anesthetic is not associated with any developmental problems. See Language Delays in Toddlers: Information for Parents for more information.
Q: My 18-month-old has a large cut on her face, and the pediatric surgeon wants to sew it up in the operating room. Is it safer to get a little sedation in the emergency department or anesthesia in the operating room?
A: A complex cut on the face will take a long time to repair well, and it will require your child to be very still. General anesthesia in the operating room is a better and safer option than trying to sedate your child in the emergency department. See Cuts, Scrapes & Scar Management: Parent FAQs for more information.
No sedative medications have been shown to be safer than any others. All the medications used in the emergency department to sedate your child have shown to lead to memory and learning problems in animals.
Have more questions?
If you have other questions, please contact your local children's hospital and ask to talk to a pediatric anesthesiologist.
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