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Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.
EDITORIAL
Use of anaesthetics in young children
Consensus statement of the European Society of
Anaesthesiology, the European Society for Paediatric
Anaesthesiology, the European Association of Cardiothoracic
Anaesthesiology and the European Safe Tots Anaesthesia
Research Initiative
Tom G. Hansen
European Journal of Anaesthesiology 2017, 34:327–328
Jointly published in Pediatric Anesthesia 2017, 27:558–559
Experimental studies have shown that general anaes-
thetics may cause a variety of morphological changes
in the developing immature brain of laboratory animals.
1
In addition, there is some evidence that long-term and
prolonged exposure may be worse than short-term
exposure in some animal species.
2,3
However, the
relevance of these findings in human beings is currently
unknown,
4,5
and studies have shown controversial
results.
6–8
Although a number of investigations in
humans have demonstrated an association between sur-
gical and anaesthetic exposure and negative neurodeve-
lopmental outcome,
9–11
several others have been unable
to find such an association or only in a minor subset of
exposed children with or without extensive individual
neurocognitive testing.
12– 18
It remains, therefore, very
difficult to identify whether any negative neurodevelop-
mental effects are because of the anaesthetic drugs, the
conduct of anaesthesia, surgical trauma or the underlying
clinical conditions.
3–19
Importantly, however, two prospective human studies,
with the most robust designs, indicate that short-term
single exposure of 60 min or less to surgery and anaes-
thesia is not associated with measurable long-term neuro-
developmental problems.
12,16
Food and Drug Administration statement
On the 14th of December 2016, the Food and Drug
Administration (FDA) issued a warning statement for
the United States of America regarding the use of anaes-
thesia or sedation in young children (and pregnant
women).
20
This statement highlights potential risk of
anaesthetic procedures that last longer than 3 h or
multiple procedures required in children less than 3 years
of age. The evidence to support such warning is currently
insufficient and incomplete. Therefore, this FDA
warning is not shared by the European Societies listed
below.
The European Society of Anaesthesiology/
European Society for Paediatric
Anaesthesiology/European Association of
Cardiothoracic Anaesthesiology/European
Safe Tots Anaesthesia Research Initiative
consensus statement
No child or pregnant woman should ever undergo any
medical procedure that is not necessary. Similarly, young
children (and pregnant women) should not undergo
surgery and general anaesthesia for trivial reasons. How-
ever, delaying or avoiding surgery may result in a signifi-
cant and real risk of a variety of adverse outcomes. If an
invasive procedure is necessary, adequate anaesthesia/
analgesia are mandatory. Indeed, there is good evidence
that inadequate anaesthesia and analgesia may result in
significant and serious complications.
21,22
There is cur-
rently no evidence to support the suggestion that a
change from established techniques for prolonged or
repeated procedures would have any impact on long-
term outcomes including neurocognition and develop-
ment in young children.
Eur J Anaesthesiol 2017; 34:327–328
From the Department of Clinical Research – Anaesthesiology, University of Southern Denmark, Odense, Denmark
Correspondence to Tom G. Hansen, MD, co-Chair of European Safe Tots Anaesthesia Research Initiative, Department of Clinical Research – Anaesthesiology,
University of Southern Denmark, Odense, Denmark
E-mail: tomghansen@dadlnet.dk
0265-0215 Copyright ß2017 European Society of Anaesthesiology. All rights reserved. DOI:10.1097/EJA.0000000000000629
Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.
Furthermore, the implied ‘safe’ cut-off points of age
3 years or duration of procedure of 3 h quoted in the
FDA warning statement are not currently supported by
evidence derived from human studies.
Given the uncertainty in this domain, it is reasonable to
discuss all aspects of perioperative safety with patients,
parents and families. However, discussion of hypothetical
risks based primarily on animal research not confirmed in
human studies may create anxiety.
Established well tolerated anaesthetic techniques
delivered by trained and experienced staff in a paediatric
environment supported by the necessary clinical organ-
isation are essential factors for the delivery of well
tolerated anaesthesia and sedation in children.
23
Conclusion
There is currently no compelling evidence to change
anaesthetic practice, but anaesthesiologists should pro-
vide adequate information on the risks of avoiding a
necessary intervention/anaesthesia procedure as well as
on the potential risks associated with anaesthetic pro-
cedures. The European Societies listed above participate
in international collaborations and support the principles
of well tolerated conduct of anaesthesia in children and
pregnant women. Information for parents and infor-
mation for anaesthetists will be updated as and when
new issues arise.
Acknowledgements relating to this article
Assistance with the Editorial: none.
Financial support and sponsorship: none.
Conflict of interest: none.
Comment from the Editor: this Editorial was checked and accepted
by the editors but was not sent for external peer review. TGH is an
Associate Editor of the European Journal of Anaesthesiology.
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328 Hansen
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