The Young Brain and Anesthesia: ASA Initiatives

Dr. MasonBy Linda J. Mason, MD
Loma Linda University
President-Elect, American Society of Anesthesiologists

Certainly, concerns regarding the unknown risk of anesthesia on children’s brain development is top of mind for us every day in our practices, with our patients and their parents. But in the past year with the FDA warning on general anesthesia in young children and pregnant women, this issue seems to be ever present in the media, the general public and various governmental or regulatory agencies.

The ASA and the specialty of anesthesiology has long been steadfast in its dedication to patient safety. Regarding this topic there are a few developments transpiring currently about which I wanted to inform you. Sulpicio G. Soriano, MD, FAAP, FASA, Chair of ASA’s Committee on Pediatric Anesthesia, has invited leading experts Raeford E. Brown, Jr., MD, FAAP, Chair of the Section on Anesthesiology and Pain Medicine at The American Academy of Pediatrics and Chair of the FDA Advisory Committee on Anesthetics and Analgesic Drug Products; Randall P. Flick, MD, MPH, Society for Pediatric Anesthesia President and Mayo Study Group; Lena S Sun, MD, FAAP, DABA SmartTots and PANDA Study Group and Mary Ellen McCann, MD, MPH, FAAP, member of the FDA Anesthetic and Analgesic Drug Products Advisory Committee /Special Government Employee and GAS Study Group,  to draft an ASA Consensus Statement that may be presented to the ASA Board of Directors at their October meeting in San Francisco.

Their findings along with several related panels and refresher course lectures have been accepted and will be presented at the October ANESTHESIOLOGY® 2018 meeting. Additionally, two reviews regarding the topic were recently published in the Online First edition of Anesthesiology, ASA’s peer-reviewed journal: the first, Exposure of Developing Brain to General Anesthesia: What is the Animal Evidence by Vensna Jevtovic-Todorovic, MD, PhD, MBA, which focused on nonhuman primates and compared the primate findings to previously published work done in rodents; and second, Clinical Evidence for Any Effect of Anesthesia on the Developing Brain by Andrew J. Davidson, MBBS, MD, FANZCA, and Dr.  Sun, which focused on several important human studies that investigate if anesthesia exposure in childhood affects the developing human brain. Three editorials on the topic are scheduled to be published in the April issue of Anesthesiology.

As this topic continues to stay “top of mind” and the public is hungry for information about it, ASA’s Public Relations Department plans to reference the reviews, editorials, possible Consensus Statement and panel in a consumer-friendly news release sharing the latest information about the effect of anesthesia on the developing brain coupled with the sentiment of the editorial authors that parents should not delay necessary surgery or procedures because of fears about anesthesia.

The news release will include advice for parents with children who need surgery that can be integrated with the information in these recent publications, along with other such other materials as a “checklist” of questions parents should ask their surgeon and physician anesthesiologist. An anecdote about a family in this situation or a story of a family who worked with a pediatric physician anesthesiologist to have their fears allayed prior to a child’s surgical procedure will also be sought to increase attention from media on the topic. Stay tuned and keep an eye out for updates on these meetings, materials and more.

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