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Multiple general anesthesia exposure before the age of two significantly increases risk of ADHD

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Pediatricians and pediatric surgeons never recommend surgery requiring general anesthesia for children unless absolutely necessary. New data confirms this advice.

A recent Mayo Clinic Study reported that infants and toddlers who were exposed to general anesthesia more than once during their young lives experienced a higher rate of learning disabilities and learning difficulties than infants and toddlers not exposed to general anesthesia.

"There is a link between ADHD and general anesthesia."

Randall Flick, M.D., M.P.H., Associate Professor of Anesthesiology and Pediatrics at the Mayo Clinic presented his findings which concluded that multiple exposures to anesthesia before the age of 2 years are a significant risk factor for the development of Attention Deficit Hyperactivity Disorder(ADHD).

Flick reported a single exposure to anesthesia did not appear to be linked with an increase of risk factor for ADHD.

Flick also said that this most recent work suggests that even when adjusted for ADHD within the population, there still appears to be an effect with multiple exposures to anesthesia before the age of two. Interestingly, the age of exposure, the cumulative length of exposure, and the number of anesthetics are critically important considerations.

Children younger than 4 years who have had two exposures to anesthesia for at least 120 min or longer each time are at least two times more likely to develop ADHD.

Merle Paule, Ph.D., Director of the Division of Neurotoxicology at the National Center for Toxicological Research and SmartTots Scientific Advisory Board member points out that studies in nonhuman primates, including rhesus monkeys, have also raised serious concerns about the effects of anesthesia on the developing nonhuman primate brain.

His recent findings demonstrate that a single 24-hour episode of ketamine anesthesia results in very long-lasting deficits in brain function in primates. Paule commented that these findings support the notion that general anesthesia during critical periods of brain development may cause functional deficits.

Flick applauded the efforts of the researchers at the National Center for Toxicological Research and calls them extremely important.

Greg Stratmann, M.D., Ph.D., Associate Professor of Clinical Anesthesia and Perioperative Care at the University of California, San Francisco, discussed whether there is an appropriate treatment for anesthesia-induced cognitive decline.

His findings support that quickly using the brain’s natural ability and plasticity to adapt to functional demands can modify the course of anesthesia-induced cognitive decline in rats. His group at the University of California, San Francisco found that in the rat model, the ill effects of anesthesia on brain function which are apparent later in life, can be overcome through environmental enrichment even when started within three weeks after exposure to general anesthesia.

Panel moderator Dr. Vesna Jevtovic-Todorovic, M.D., Ph.D., M.B.A., Professor of Anesthesiology and Neuroscience at the University of Virginia Health System and SmartTots Scientific Advisory Board member wants to impress upon people that there is a very reliable link between the animal and human data regarding anesthesia exposure that is rapidly emerging.

Reviewed by: 
Review Date: 
May 30, 2011
Last Updated:
June 1, 2011