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WISI News, March 29, 2007

March 29, 2007 By Washington-NBC

An FDA panel is looking at what happens when children are put to sleep during surgery. What, if any, are the long-term effects of anesthesia?

Determining the right level of anesthesia during surgery is critical. Too little and patients may wake up or feel pain. Too much and they may slip into a coma and die.

It’s a particular concern with children – not only during surgery, but after.

Some studies on young animals show small amounts of brain damage and mild behavioral changes from anesthetics.

Dr. Bob Rappaport with the FDA’s division of Anesthesia, Analgesics and Rheumatology, said, “It is not clear at this time what this means for the clinical setting, or for children who undergo anesthesia, whether there are any effects at all, or whether any long-term effects.”

An anesthesiologist told the FDA panel concerns about memory loss and attention deficit disorder are, so far, unfounded — but doctors do need more research on humans.

Dr. Scott Kelley said, “They want to take the laboratory findings carefully and now do new studies saying ‘let’s look a little bit closer.’ But there’s no apparent harm that we can see in young patients right now.”

This week the Cleveland Clinic announced two new studies looking at the long-term effects on adults — possible strokes, heart attacks and liver damage.

One will examine whether too much anesthesia can weaken the immune systems of breast cancer patients — causing their cancer to return after surgery.

Cleveland Clinic lead investigator Dr. Daniel Sessler, “There is almost always still cancer in the body, even if it’s just individual cells. These cells are ideally killed by the immune system, but only if the immune system is effective. Only if it is working.”

Those studies are expected to take several years.

One technique some doctors use is combining general anesthesia with a regional one, like an epidural. That allows them to deliver less anesthesia and still keep the patient comfortable, asleep and safe.