Surgery, anaesthesia and pain

Surgical expertise, pre-and postoperative care and pain management in neonates and infants have all improved greatly in recent years.

With this, the risk of anaesthesia for neonates and infants has reduced, allowing earlier surgical intervention for many paediatric conditions. The peri-operative risks of cardio-respiratory compromise, anaphylaxis, renal and liver damage are now proactively managed or mitigated.

In the last 15 years, the possibility that anaesthesia and sedative drugs may represent a previously unrecognised risk for neurobehavioral development has been raised. In December of 2016, the FDA issued a drug safety announcement warning that repeated or lengthy use of general anaesthetic agents may affect the development of children’s brains.

Carers and parents are increasingly aware of the debate and are likely to ask for further information.

This information can be provided at the time of obtaining consent with the acknowledgement that:

• At The Children's Hospital at Westmead, surgery is only carried out when necessary i.e. all surgery is done for defined clinical reasons.
• The benefit to the child (physical and/or psychological) of the intervention can be demonstrated and is a community expectation.
• Anaesthetic care is primarily focused on safety and minimising the well-recognised complications (hypotension, hypoxia, hypothermia, hypoglycaemia) of drug-induced unconsciousness.

Our understanding of the neurotoxic potential of anaesthesia drugs is growing and recommendations will be regularly reviewed.

For more information, see the following resources:

• Download Departmental statement on potential neurotoxicity of anaesthetic agents in children (February 2018)
• Read the Anaesthesia and risk in infants fact sheet