How bad is general anesthesia for infants?

July 27, 2011 11:49 AM

Should we fight to have a g-tube placed in our 10-month-old without general anesthetic? If the hospital insists on general anesthetic, should we find another provider or call the whole thing off?

This question is really for domain experts: medical professionals or scientists in related fields, or parents who have made this same decision themselves in an informed way.

Yesterday, in a big consultation with a pulmonologist, our pediatrician, a dietician and a feeding specialist, we collectively decided to put a g-tube in our daughter (who is chronologically 1 year, but was 2 months premature, and who currently has an NG tube). This was not an easy decision.

Today, I found this NPR article, based on this Anesthesiology article, indicating that general anesthesia in under-4-year-olds is linked to learning disabilities later on. The effect was only observed with two or more instances of anesthesia, but of course there's no guarantee our daughter won't need it for something else at some point. I see no real follow-up articles in the literature.

We're told that the hospital where we'll be having this done always uses general anesthesia for this procedure (though I understand that the PEG method of gastrostomy is sometimes done without general). We'll find out for sure tomorrow, when we consult with the GI doc who would perform the procedure.

This hospital (Seattle Children's) is acknowledged as the best in the area. If they say it's general or no deal, should we try to take our business elsewhere? If everyone says the same thing, should we dig in our heels and say no g-tube? The alternative is to stay on the NG tube indefinitely -- probably at least several months.

posted by gurple to Health & Fitness (13 answers total)

yeah...general anaesthesia is scary shit...the 'general' rule being 'only if there's really no alternative'...last time i had surgery i awoke to the really strange sensation of running very slowly through a pool...turns out, it was these weird inflator cuffs on my legs expanding alternately to keep my blood flowing (i have really low blood pressure)...the nurses were all like 'LOL, you almost died, haha'...yeah.
seems to me an NG tube would be much preferable, at the very least, comfort-wise, than a G tube...why do they want to switch it? bigger?
posted by sexyrobot at 11:59 AM on July 27, 2011

Response by poster: The main reason everyone wants to switch her to a g-tube is to allow us to try an intensive feeding therapy program. That involves letting her get really, really hungry, for a pretty long time, to try to get her to learn to eat (she's developmentally normal, but for historical and possibly pulmonary reasons she doesn't eat). The g-tube would let us keep that up for longer, giving her water and minimal amounts of food without leaving a tube down her throat that might currently be interfering with her ability to eat.

So, there are big reasons to prefer the g-tube. The question is, are there bigger reasons not to let them put her under?
posted by gurple at 12:04 PM on July 27, 2011

Best answer: The good folks at reflux.org are a fantastic resource for this kind of query. Though it is a site for reflux, many, many families have multiple issues and have had NG and G tube placements done for their kids. Check out the discussion boards there at PAGER. Good luck to you and your little one.
posted by PorcineWithMe at 12:08 PM on July 27, 2011

Wow, no personal experience, but I have a 16 month old and I can understand the theory behind general anesthesia for insertion of an g-tube. Your child is probably like mine in that they are a wriggly, bundle of limbs that will not stay still for nose wiping let alone insertion of medical instruments.

Are the admittedly slim chances of possible learning disabilities later on (which she may have anyway, even unrelated to the anesthesia or her prematurity just as any child in the general populaiton might have them) worth having a 10 month old subjected to the insertion of an g-tube without anesthesia? I would be more concerned about the chances for other injuries from the attempt to insert due to her wiggling around - even with many adults holding her down - than possible learning disabilities. I would vote 100% for the anesthesia.

And all the best to you - this sounds like a very difficult situation. My heart goes out to you and your family.
posted by Leezie at 12:09 PM on July 27, 2011 [3 favorites]

The problem I have with the study you linked to is that it doesn't appear to take into account that a percentage of children will have learning disabilities, and just because they received anesthesia at one point in their young lives, doesn't equate to anesthesia being the reason.

I'd also point out that a child who required three surgeries before the age of five (five years of age being a completely random age that I chose) probably had a lot of other possible contributing factors to a learning disability (besides just anesthesia administration).
posted by kuanes at 12:15 PM on July 27, 2011 [7 favorites]

And one other thing I forgot from the article:

""My advice is that if their child needs a surgical or diagnostic procedure that requires an anesthetic, then they should go ahead and have that surgical or diagnostic procedure with the anesthetic," he [Dr. Robert Wilder, whose study this is] says.
posted by kuanes at 12:18 PM on July 27, 2011 [1 favorite]

Remember, correlation is not causation.

"These data cannot reveal whether exposure to anesthesia itself may contribute to the pathogenesis of LD or whether the need for anesthesia is a marker for other unidentified confounding factors that contribute to LD."

...meaning, these children may have required anesthesia because of conditions which also contributed to learning disorders. You could possibly make a correlation between putting bandaids on five year old boys, and a larger number of broken bones later in life, because people who take more physical risks are likely to need bandaids as a kid and likely to break their bones later in life. That doesn't mean you shouldn't give your kid a bandaid when they scrape their knee.
posted by Jairus at 12:22 PM on July 27, 2011 [4 favorites]

I'm not an expert or a doctor, but having read that article, my "Correlation is not causation" alarms are going off all over the place.

We could very easily reword the conclusions of that study to say that "Children born with severe medical conditions requiring major surgery and two or more instances of general anesthesia have a slightly elevated chance of developing learning disabilities later in life."

The last paragraph of the study acknowledges this nicely:

In conclusion, in this population-based birth cohort, exposure to anesthesia before age 4 yr was a significant risk factor for the later development of LD in children receiving multiple, but not single, anesthetics. These data cannot reveal whether exposure to anesthesia itself may contribute to the pathogenesis of LD or whether the need for anesthesia is a marker for other unidentified confounding factors that contribute to LD. However, these results suggest that the possibility of potential adverse effects of repeated anesthetic exposures on human neurodevelopment cannot be excluded.

Also, again, not an expert, but prolonged use of an NG tube seems horrifically unpleasant (have you ever had a tube shoved down your nose? let me tell you, it sucks, and eating was painful for several days afterward). I'm not sure you're going to find a doctor that finds this method appropriate.

Now, this isn't something to take lightly, and you're being a good parent for researching this. However, my reading of that study doesn't make me want to panic (although, again. I'm not a doctor or a parent). The study also only considers babies from 5 towns in Minnesota, born at a single hospital between 1976-1982. That's an awfully narrow sample from a very long time ago.
posted by schmod at 12:26 PM on July 27, 2011 [1 favorite]

On Preview: Everyone else beat me to it.
posted by schmod at 12:26 PM on July 27, 2011

Best answer: I'm a pediatric neuropsychologist and researcher (and a parent): Nthing all of the above: the correlation does not tell us the cause of the learning disability and even then the risk is remote. The other thing to consider is that we know that other factors certainly contribute to learning difficulties with inadequate early nutrition also being something we know is a signficant contributer to cognitive problems. Feeding issues are also an enormous strain to families and kids and are much more easily addressed when the kids are younger than when food avoidance has firmly taken root. IANAD, but I'm not aware of a way to place a g-tube with local anaesthetic as it involves incisions in several kinds of tissue.
posted by goggie at 12:55 PM on July 27, 2011 [6 favorites]

I'm parent who likes to make well informed decisions. I had to make a decision about GA and a young child. After much research and consideration of many options, I went with the GA, because I weighed up the costs of my child incurring further complications from struggling or complications from trauma. Trauma itself can damage the brain and, if your child has medical issues, you don't want to take the risk of your child having that same trauma triggered in subsequent medical visits. I haven't had a g-tube myself, but I have had some nasty procedures without sedation or with failing sedation, and I wouldn't want to put a child through that, in case it traumatized them and affected their future health and wellbeing.
posted by acoutu at 1:55 PM on July 27, 2011

I am a parent who had to have his child put under GA for surgery at 6 weeks of age.
What the other posters have said about correlation/causation. Also, this quote from your question leaped out at me:

..there's no guarantee our daughter won't need it for something else at some point

It sounds like the g-tube is something that pretty-much has to happen, right? That being the case, I'd suggest crossing the "might require later surgery" bridge if and when you come to it - your child might never need another GA in their life.
Don't use a future "maybe" as a reason to not have a currently necessary procedure done now.
posted by coriolisdave at 8:19 PM on July 27, 2011

IANYD. If it were my child I would get it done with general anesthesia.
posted by treehorn+bunny at 10:28 PM on July 28, 2011