September 28, 2008
Whether anesthesia, or surgery, or some combination of the two, have long-lasting effects on the brain of children is an important question which researchers are trying very hard to answer. Three new studies provide some cause for concern.
In a non-clinical, (epidemiologic), study from Columbia University the authors used databases to review cases in which children had hernia surgery in the first four years of life. They found that these children, compared with a control group, had almost twice as much risk of subsequently developing behavioral or developmental disorders.
In a second study, from the Mayo Clinic, the risk of learning disabilities in children after a single anesthetic was not different from a control group but the risk did increase after two or three anesthetics and in the cases where the duration of the anesthetic was longer than 2 hours.
Finally, a Dutch study of children who had urologic surgery. “Neurocognitive” development was evaluated by means of a questionnaire completed by parents. Children who had their procedures before the age of two years had lower scores but the study wasn’t large enough to say with any certainty that this age cut-off is important. Read the rest of this entry »
February 17, 2008
What could be more frightening that being awake but paralysed and unable to breathe? No, I’m not talking about “Awake”, the scientifically inaccurate recent movie that dramatizes the rare but distressing experience of being awake in the middle of surgery. Rather, I am referring to the equally upsetting events that sometimes occur during recovery from general anesthesia.
Here is a vivid description, sent to a forum on the excellent consumer health site NetWellness, where I field questions about anesthesia:
“I have just had my ovaries and tubes removed because of my family history. When I woke in the recovery room, I had the most terrible experience of my life. My eyes were open, but I could not move or breath. No air would go in or out, I could not raise my arms in distress or do anything to raise the alarm that I could not breath, only stare into the eyes of the nurse. I thought, any minute now I am going to die, It was so distressing, I have been having flash backs ever since.” Read the rest of this entry »
January 11, 2008
Sleep disturbance after major surgery is common, and some people assume anesthesia is the cause. That is probably wrong.
The “surgical stress response“, the body’s hormonal and metabolic response to the trauma of surgery, is quite profound and has an important effect on the subsequent amount and quality of sleep. The bigger the surgery, it seems, the more significant is the stress response and the accompanying sleep disturbance.
During the stress response, hormones from the pituitary gland are released, and the sympathetic nervous system is activated (adrenaline and its companion “fight or flight” hormones). Metabolic changes include increased blood sugar, and breakdown of body protein. Injured tissues release cytokines and other potent chemicals associated with inflammation.
Pain, and the medications used to treat pain, sedatives, food deprivation, fever, psychological factors, age, and a person’s usual sleep profile all affect sleep after surgery.
Read the rest of this entry »