![]() : Early Exposure to Anesthesia and Learning Disabilities in a Population-based Birth Cohort RT Wilder, RP Flick, J Sprung, SK Katusic. ![]() Such preclinical research should also include Halothane + Nitrous Oxide, used in this study and another, in order to strengthen translational validity.Ĭlarification on why duration was not included in the analysis, as it was in the previous study, would be helpful. ![]() It would also be an example, seemingly rare in this topic, where clinical findings drive preclinical research. If it can be ascertained that multiple short procedures are as, or more, likely than single long exposures to induce cognitive deficits in children, perhaps preclinical animal studies should also focus on the effects of repeated inductions, in addition to prolonged exposures, as they currently do. ![]() It may certainly be the case that a single exposure of significant length is less risky than 2 or more exposures of shorter duration, however, this would seemingly conflict with animal studies where pathological and neurocognitive effects were reported after single exposures of a length exceeding 2 hours, and where length of exposure seems to be an important factor in inducing apoptosis (assuming, of course, that apoptosis is indeed the cause of these learning deficits). It should be noted that, unlike a previous study by the same group, where more than two hours of cumulative anesthesia duration was reported as associated with increased risk of learning disabilities in children under 4, there is no mention of the impact of cumulative anesthesia duration on risk in this study. "Neonatal exposure to sevoflurane induces abnormal social behaviors and deficits in fear conditioning in mice". CG112 Sedation in children and young people: NICE guideline. References: Cognitive and Behavioral Outcomes After Early Exposure to Anesthesia and Surgery Randall P. More studies are definitely needed to elaborate on the possible neuro-degenerative side- effects with the modern anaesthetic agents in use today. To summarise, we would like to point out that modern anaesthetic agents combined with good pre-medication are clinically different from the choice of available anaesthetic agents 35 years ago. In one, the researchers showed exposure of infant mice to inhaled sevoflurane resulted in learning deficits and abnormal social behaviour. This activity is, as the authors point out in the case of halothane, thought to occur via blockade of NMDA receptors or hyperactivity of GABA neurotransmission. Sevoflurane has also been implicated in neuronal degeneration in infant mice. The incidence of halothane hepatitis is also noted to be higher after repeated/multiple exposures. The solubility of halothane in tissues is also much higher, so recovery after anaesthesia is delayed. 3% of the absorbed sevoflurane dose is metabolised. Compared to sevoflurane: By hepatic cytochrome P450IIEI to yield hexafluoroisopropanol, which is further conjugated to its glucoronide. Halothane: 20% metabolism: 20% of dose is metabolised in the liver (oxidation/dehalogenation to yield trifluoroacetic acid, trifluoroacetylethanolamide, chlorobromidifluorethylene, and chloride and bromide radicals. The new induction agents currently in use today (Oxygen, sevoflurane) are much less metabolized than halothane. ![]() We would like to point out that the anaesthetic agents in use during the referenced time used for the purpose of this study (1976-1982) was a period of rapid advances in the field of Anaesthesia and Critical Care. They point out the epidemiologically significant increase in the development of learning difficulties and speech/language impairment associated with multiple exposures to anaesthetic agents in early childhood as a possible risk factor among matched cohorts. We read with interest the well written article of Dr Flick et al on Cognitive and behavioral outcomes after early exposure to Anaesthesia and surgery. ![]()
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