Q: Is it safe to give anesthesia to my young child?

A: I have often heard anesthesiologists compare the safety of general anesthesia to that of driving an automobile. Driving or riding in an automobile could result in an unexpected, life-threatening accident through no fault of our own. Nevertheless, the chance of such an accident is so rare that we confidently use automobiles on a daily basis. In the same way, the chance of a life-threatening complication from anesthesia is exceptionally rare for most routine ear, nose and throat procedures.

Parents were frightened in December 2016 when the FDA proposed a warning label  to anesthetic drugs stating that “exposure to these medicines for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years.” Further clarification published April 27, 2017 emphasized that this statement was based on studies of young animals and pregnant animals undergoing anesthesia for more than 3 hours. The FDA guideline further recognized that most surgeries performed on young children and pregnant women are of short duration and generally medically necessary.

The majority of common ear, nose and throat procedures performed on children under the age of 3, such as myringotomy with tubes, adenoidectomy, removal of foreign bodies and examination under anesthesia, require less than thirty minutes of anesthesia. The FDA warning clearly states that “surgeries or procedures in children younger than 3 years should not be delayed or avoided when medically necessary.” A recent opinion published in JAMA Otolaryngology-Head and Neck Surgery  noted that human studies of children who received less than one hour of general anesthesia in the first 3 years of life showed no difference in cognitive development compared to siblings who did not require surgery or to control patients who had similar surgery under local or regional anesthesia. The letter concluded that untreated hearing loss caused by fluid in the ears, or loss of oxygen to the brain caused by obstructing tonsils and adenoids is far more likely to cause developmental delay then the brief general anesthetic required to fix the problem.