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FDA Warning on Anesthesia is Misguided

January 18, 2017

 

First, Happy New Year! I hope you all had a wonderful and restful holiday season.

 

Unfortunately, the Food and Drug Administration started off my holiday season with a lump of coal last month when they announced it was requiring new warnings on the use of repeated or lengthy general anesthesia in children under age 3 because of their possible effectson the developing brain.

 

While I share the FDA's concern, this action is an example of a government bureaucracy taking action in the absence of scientific and clinical evidence. To date, there have been no human studies that have demonstrated that anesthesia causes developmental problems in children. On the contrary, numerous studies have demonstrated that short, isolated anesthesia experiences have had no effect on cognitive performance in children.

 

So why did the FDA make this misguided announcement? Their concern is based on studies in young animals and other species (such as flatworms!), that have found that repeated or prolonged exposure to general anesthesia might have negative effects on the developing brain.

 

However, these animal findings do not correlate well to human children for several reasons:

 

1. The animals were exposed to high doses of anesthetics for long periods, which does not happen to children undergoing dental anesthesia in the office. 

 

2. The animals did not actually have surgery, and of course, we can only study anesthesia in children who have a need for surgery.  The effects of surgery and pain are powerful factors that have to be considered when giving anesthesia. As a result,  it is difficult to make any conclusions from these animal studies that are not conducted in the context of surgery or pain. 

 

3. .Brain development is different in human infants than in animals, and animals experience development over a much more rapid period than human children.  Thus, animal brains may be much more susceptible to the effects of anesthesia. 

 

In fact, the same FDA announcement noted that one, short procedure under general anesthesia is UNLIKELY to have negative effects on the brain.

 

And while the effects of anesthesia are unproven, we know that there are definite consequences to NOT performing a dental procedure in children  - dental pain, tooth decay, and infection are known complications.

 

In summary, I agree with the statement by Dr. Rita Agarwal, chair of the American Academy of Pediatrics' Section on Anesthesiology and Pain Medication: "The {scientific} literature is so murky right now that I believe that the FDA has done a disservice to the population by putting out these warnings."

 

Nevertheless, as a fellow parent whose children had dental anesthesia, I can empathize with parents' concerns about anesthesia. Thus, I am always available to answer your questions, review your options, and will always strive to deliver the safest anesthesia experience for your child.

 

 

 

 

 

 

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