Surgical Anesthesia in Young Children Linked to Effects on IQ and Brain Structure

According to a study published in the journal Pediatrics, children who received general anesthesia for surgery before age 4 had diminished language comprehension, lower IQ and decreased gray matter density in posterior regions of their brain.

These findings were reported in the June edition from researchers at Cincinnati Children’s Hospital Medical Center. The team say this knowledge could make it possible to develop mitigating strategies for what the authors describe as a potential dilemma for child health, and recommend additional studies to determine anesthesia’s precise molecular effects on the brain, and contribution to diminished brain function and composition.

Andreas Loeppke, MD, PhD, FAAP and lead author of the study stated that “he ultimate goal of our laboratory and clinical research is to improve safety and outcomes in young children who have no choice but to undergo surgery with anesthesia to treat their serious health concerns.”

Loepke and his colleagues have published previous studies showing widespread cell death, permanent deletion of neurons and neurocognitive impairment in laboratory rats and mice after exposure to general anesthesia. These studies have raised concerns about similar effects in young children during a particularly sensitive neurodevelopmental period in early life, which researchers say could interfere with the refinement of neuronal networks and lead to long­term functional abnormalities.

In this study, Loeppke and his colleagues compared the scores of 53 healthy participants of a language development study (ages 5 to 18 years with no history of surgery) with the scores of 53 children in the same age range who had undergone surgery before the age of 4.

According to the researchers, the average test scores for all 106 children in the study were within population norms regardless of surgical history. However, children exposed to anesthesia scored significantly lower in listening comprehension and performance IQ compared with children who had not undergone surgery. The researchers also report that decreased language and IQ scores were associated with lower gray matter density in the occipital cortex and cerebellum of the brain.

By using extensive analysis of surgical and other medical records the researchers were able to match the children for age, gender, handedness and socioeconomic status – all confounding factors of cognition and brain structure. The types of surgeries and length of exposure to anesthetics were also factored in and the anesthetics used during the surgeries included common agents such as sevoflurane, isoflurane or halothane (used alone or in combination) and nitrous oxide.

Brain structural comparisons were conducted by MRI scans. and the children included in the study did not have a history of neurologic or psychological illness, head trauma or any other associated conditions. Neurocognitive assessments included the Oral and Written Language Scales and the Wechsler Intelligence Scale.

Loeppke and his team’s current study estimates that of the 6 million children who undergo surgery in the United States each year could experience a loss in the potential loss of 5 or 6 IQ,and that the lifetime potential earnings loss could total $540 billion. Previous research from 2008 had estimated the loss of 1 IQ point to decrease a person’s lifetime earnings potential by $18,000.

He and his team advise parents who are concerned to discuss with their pediatrician and surgeon the risks of a surgical procedure – and the potential risk of anesthetic exposure – versus the risks of not having a surgery, and insists that current methods are still very safe.

“It is important to note that no surgeries are truly elective in young children,” Loepke says.

“Many surgical procedures early in life treat life­threatening conditions, avert serious health complications, or improve quality of life. These cannot be easily postponed or avoided.”

He also stressed that researchers at Cincinnati Children’s are actively looking for alternative anesthetic techniques in their ongoing laboratory studies, and that there is ongoing research into drugs are being tested that show potential for lessening the harmful effects of anesthetics in laboratory rats and mice. Additionally, the medical center is participating in an international clinical trial to test an alternative anesthetic regimen in young children undergoing urological procedures.

Surgeries for Hanging Skin Removal Boom in Wake of Weight Loss Surgeries

According to the American Society of Plastic Surgeons, weight loss surgeries are on the rise, and with it we’ve seen increases in the frequency of procedures associated with weight loss, such as tummy tucks, breast lifts, thigh and upper arm lifts.

“We’re seeing exponential growth in concurrent surgeries, and we’re realizing that this is really a continuum of care for these patients” stated ASPS President Dr. Scot Glasberg in an interview with Reuters “Hanging skin can be very painful and get in the way for daily activities.”

In the latest report from the ASPS an estimated 1.7 million cosmetic surgeries were performedby board­certified surgeons in the United States. Breast lifts were up 3% since 2013 and 75 percent since 2000, with an estimated 92,724 performed in 2014. Among people who experienced massive weight loss, the procedures increased by 10% just since 2013.

Tummy tuck and thigh lift procedures increased by five% between 2013 and 2014 and more than 70% each since 2000. Upper arm lifts are up over 4000% compared with statistics reported in the year 2000, skyrocketing from about 300 to 16,000.

According to the American Society for Metabolic and Bariatric Surgery, there were almost 180,000 weight loss surgeries in the U.S. in 2013.

University of Michigan in Ann Arbor chief of minimally invasive surgery Dr. Justin B. Dimick states that “bariatric surgery has become much more common over the past decade, as these patients lose weight they may have excess ‘loose’ skin and need plastic surgery procedures to remove it a year or two later.”

Roughly one in five people who have weight loss surgery will need body contouring as well, he said.

Currently, insurance covers most bariatric surgeries but covers less than half of post­weight loss body contouring procedures, according to Glasberg. He states that those who can get body contouring after weight loss are some of the happiest patients in his practice, he said, and warned that patients pursuing weight loss surgery and body contouring should make sure they see a board certified plastic surgeon at an accredited facility.

Migraine Surgery Found Effective For Teens With Severe Headaches

A recent study indicates that new surgery options for may be beneficial for teens with severe migraines that don’t respond to typical treatments, a young migraine surgery may be beneficial.

Researchers of the American Society of Plastic Surgeons (ASPS) note in a news release that the surgery works via “trigger sites” in the nerve branches that produce headaches, identified by preoperative evaluation.

“Our data demonstrate that surgery for refractory migraine headaches in the adolescent population may improve and potentially completely ameliorate symptoms for some,” researchers state. The trigger sites are detected based on a constellation of symptoms, including nerve blocks, ultrasound doppler and CT scans.

The surgery was conducted in 14 patients under the age of 18, including 11 females and three males, the average of 16 years old, some of which had reduced headache activity after undergoing cosmetic forehead procedures from 2000. All patients experienced debilitating migraine attacks that continued despite recommended medications, Average follow­up was about three years, and at least one year in all patients.

The findings revealed that the surgery was highly effective in reducing migraines, and that the average headache frequency decreased from 25 per month before surgery to five per month afterward. Participants indicated that the average migraine severity score then decreased from 8.2 to 4.3 on a ten­point scale, and that the average migraine times also decreased from about 12 to 4 hours. Additionally, 5 of the 14 patients reported being migraine­free following surgery, while one patient had no change in migraine frequency but less attacks over shorter periods.

Bahman Guyuron, MD Emeritus professor of plastic surgery at Case School of Medicine, Cleveland noted that “identifying the adolescent patient who would benefit from surgery is the most important aspect of surgical intervention” and that he and his colleagues emphasized the need for “more in­depth and prospective studies” to confirm the effectiveness of migraine surgery, and to weigh the risks and benefits of surgery for younger patients.