Neuraxial Labor Analgesia for Vaginal Delivery and Its Effects on Childhood Learning Disabilities

Flick, Randall P.; Lee, K.; Hofer, Roger E.; Beinborn, Charles W.; Hambel, E. M.; Klein, Melissa; Gunn, Paul W.; Wilder, Robert T.; Katusic, Slavica K.; Schroeder, D. R.; Warner, David O.; Šprung, Juraj

doi:10.1097/01.aoa.0000414049.41191.bf

Cited by 10 publications

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“…No entanto, os autores observaram o menor risco potencial de distúrbio de aprendizagem em crianças nascidas por cesariana cujas mães foram submetidas a anestesia regional em comparação com as nascidas por parto vaginal, tendo sido tal resultado atribuído a possível enviesamento de seleção. Numa tentativa de esclarecer este último resultado, Flick et al 40 avaliaram retrospetivamente a coorte desta base de dados de adolescentes nascidos por via vaginal de mães submetidas a analgesia de parto por técnicas de abordagem do neuroeixo, tendo concluído que a exposição a este tipo de analgesia de parto não alterou o risco de desenvolver distúrbio de aprendizagem em comparação com os controlos não expostos. Noutro estudo, Flick et al 35 procuraram determinar se os efeitos de múltiplas exposições a anestesia demonstrados anteriormente nesta população persistiam quando se tinham em conta diferenças no estado de saú-de e se também se verificavam em testes de desempenho cognitivo em grupo e na necessidade de um programa escolar de educação individual dirigido a distúrbios de comportamento/emocionais ou dirigido a alterações de linguagem.…”

Section: Resultsunclassified

Anestesia Pediátrica em Período de Imaturidade Cerebral e Perturbações do Neurodesenvolvimento

et al. 2014

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Introduction: Several experimental and clinical studies suggest that drugs used in pediatric anesthesia may exert undesirable effects on the developing central nervous system. The objective of this review was to assess the results and conclusions of published studies on long lasting neurodevelopment disorders following exposure to anesthetics in children in a phase of brain immaturity. Material and Methods:We performed a literature search in several sources (PubMed, SciELO and Cochrane Library) using the terms 'Pediatric anesthesia OR Pediatric anesthetic OR Developing brain anesthetic OR Developing brain anesthesia AND behavior disorders'. We selected human studies, referring to long lasting neurodevelopment effects after exposure to anesthetics in the first four years of life. Results: Ten retrospective studies met the inclusion criteria. Of these, seven suggest risk of neurobehavioral disorders after exposure of small children to anesthetics, as opposed to the results obtained by the other three. Discussion: Although mostly using large databases, the studies found are retrospective, vary in test groups, include sometimes avoidable confounders and some present inaccuracies in the choice of the test and control populations that can compromise the reliability of the results. Conclusion: Because of the numerous limitations of the few studies available, the reported results are still deemed insufficient to change current clinical practice. However, although it is undisputable that anesthesia should be provided when needed, regardless of age, the warnings found in literature are worrisome, therefore whenever surgery is unavoidable in small children, alternatives that may help reduce the risks of anesthetic exposure should be sought.

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Section: Resultsunclassified

Anestesia Pediátrica em Período de Imaturidade Cerebral e Perturbações do Neurodesenvolvimento

et al. 2014

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“…The efects of anesthesia used during cesarean procedures were examined in children. Infants born under regional anesthesia exhibited fewer learning diiculties in the later stages of their life [69,70].…”

Section: Clinical Studiesmentioning

confidence: 96%

“…Flick et al determined that neuraxial labor analgesia for vaginal delivery did not cause learning disabilities in childhood [69,70].…”

Section: Clinical Studiesmentioning

confidence: 99%

Anesthetic Neurotoxicity in Pediatric Patients

Özer¹,

Özcan²

2017

Current Topics in Anesthesiology

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In recent years, an increasing number of publications have shown the negative efects of anesthetics on the developing brain and have made inquiries about anesthesia for pediatric patients in practice. Anesthesia is applied to millions of children for surgery, imaging, and other invasive procedures; the issue is very serious and concerns. In this chapter, experimental and clinical studies about the issue have been summarized. As a result, anesthetic drugs except alpha-2 adrenergic agonist anesthetic (NMDA antagonist or a GABA agonist) used in pediatric patients (especially if there is no painful situation) have potential neurotoxicity. Particularly, if anesthesia exposure was applied in the fragile period (the irst 4 years) and if used at higher concentrations or repeated anesthesia application, adverse efects of anesthesia exposure on the developing brain have been claimed. But, the issue is not fully clariied yet.

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“…Further, LD is not a specific neuropsychological outcome measure, but a categorical determination based on inconsistencies between a child's educational expectations, such as intelligence quotient, and his or her actual achievement [10 • , 11, 30 • , [31][32][33].…”

Section: Relevant Outcome Measurementioning

confidence: 99%

Neurotoxicity, General Anesthesia, and the Developing Brain: What have We Learned from the Human Studies so Far?

Hansen

2013

Curr Anesthesiol Rep

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A multitude of animal studies have shown that virtually all general anesthetics used in clinical practice exert detrimental effects on the developing brain, notably enhanced neuroapoptosis. Some studies have also indicated that animals exposed to general anesthesia may experience long term neurobehavioral deficits later in life. The neurotoxic effects seem to be dose-dependent and have been suspected to occur at certain early developmental stages. Initially, the animal studies comprised primarily rodents but recently they have been confirmed in non-human primates. Recently, a number of (mainly retrospective) human cohort studies have been published with inconsistent results. While some studies have indicated an association between anesthesia and surgery and adverse neurobehavioral outcome, other studies have indicated no association. The cohort studies have many constraints and shortcomings. While prospective studies are underway, they will not provide any answers for several more years. The aim of this review is to provide the reader with a summary of recent human cohort studies and discuss their limitations and weaknesses. Although disturbing, the animal data lacks verification in humans. To date there are no data to support any change in clinical pediatric anesthetic practice. Any such change will be premature and potentially dangerous until we have evidence as to if and how general anesthesia impairs neurocognition and behaviour in infants and young children.

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Neuraxial Labor Analgesia for Vaginal Delivery and Its Effects on Childhood Learning Disabilities

Cited by 10 publications

References 0 publications

Anestesia Pediátrica em Período de Imaturidade Cerebral e Perturbações do Neurodesenvolvimento

Anestesia Pediátrica em Período de Imaturidade Cerebral e Perturbações do Neurodesenvolvimento

Anesthetic Neurotoxicity in Pediatric Patients

Neurotoxicity, General Anesthesia, and the Developing Brain: What have We Learned from the Human Studies so Far?

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