By Tara Haelle 
 
 HealthDay Reporter 
 
 (HealthDay) 
 
 MONDAY, June 8, 2015 (HealthDay News) -- Having general anesthesia during surgery at a very young age may be linked to poorer brain development, new research suggests. 
 
 Children who had received general anesthesia during surgery before they turned 4 years of age later scored slightly lower on listening comprehension and parts of an IQ test, compared to children who had never had general anesthesia, the researchers found. The children's overall IQ scores, however, remained within the normal range. 
 
 "It is difficult to see whether this decrease had any functional effect for an individual child," said study author Dr. Andreas Loepke, a professor of clinical anesthesia and pediatrics at the University of Cincinnati College of Medicine. 
 
 But, he added, "these concerns make it obvious that a lot more research is needed to better understand the effects of anesthetics on brain development." 
 
 The findings, published online June 8 and in the July print issue of the journal Pediatrics, echo those of earlier studies that have pointed to a similar link. 
 
 Loepke and his colleagues compared 53 children who had undergone surgery using general anesthesia before they were 4 years old with 53 children who had never been exposed to general anesthesia. Each child from the first group was matched to a child in the second group according to age, sex, socioeconomic status and being left- or right-handed. 
 
 All of the children underwent IQ and language development testing as well as imaging with an MRI. The scores for all the children in both groups were within the normal range. 
 
 But the children with a history of surgery had listening comprehension and performance IQ scores that averaged 3 to 6 points lower than the kids without surgery. Performance IQ refers to several combined components from an overall IQ test. A score of 100 is considered average. 
 
 In addition, those with a lower performance IQ and listening comprehension had slightly less gray matter in two areas at the back of their brains, the researchers found. 
 
 "The very receptors that anesthetics act on to produce unconsciousness during surgery are also important for stimulating neurons to form proper connections and to survive," Loepke said. "Anesthetic exposure may interfere with normal brain development." 
 
 However, one expert cautioned, this small study only shows a link between lower scores and a history of general anesthesia. It cannot show that anesthesia caused brain development problems, said Dr. Raafat Hannallah, a pediatric anesthesiologist at Children's National Health System in Washington, D.C. 
 
 "Studies in children have limitations that prevent experts from understanding whether the harmful effects, if any, were due to the anesthetic drugs or to other factors, such as the surgery or related illness," Hannallah said. 
 
 Loepke also mentioned other factors that can occur during surgery that might have unknown effects, such as inflammation, pain or the underlying medical problem being treated. 
 
 "Hence, our study cannot conclusively identify any of these factors to be the cause for the reported findings," he said. 
 
 In addition, skipping surgery may lead to similar or worse concerns about brain development, Loepke pointed out. 
 
 "Surgery is only performed to save lives or to prevent serious health complications," Loepke said. "So not performing these crucial surgeries may put the child at greater risk for developmental complications than the theoretical risk linked to the anesthetic exposure." 
 
 The majority of children in this study underwent surgery for ear, nose or throat conditions, especially hearing conditions. General surgery and urology comprised the other two common surgery types. 
 
 "Concerns regarding the unknown risk of a surgical procedure and anesthetic exposure to a child's brain development must be weighed against the potential harm associated with canceling or delaying a needed surgical or diagnostic procedure," Hannallah said. "The child's doctors, including the physician anesthesiologist, are best able to provide this advice." 
 
 For those children who need surgical procedures, anesthesia and surgery today are "safer than ever," Loepke added. "Survival is much improved even for critically ill babies and procedures that were unthinkable just two or three decades ago," he said. 
 
 At least two previous studies, one from Australia and the other from the Mayo Clinic, also published in Pediatrics in 2011 and 2012, also found a potential link between anesthesia in young children undergoing surgery and language deficits. 
 
 Researchers are continuing to study both animals and children to learn more about whether anesthetics have any effect on brain development, Loepke said, but these findings should not be used to delay a necessary procedure. 
 
 "Bottom line, kids do not undergo anesthesia for the fun of it," Hannallah said. "They do because they need a surgical or diagnostic procedure to keep them healthy or cure an existing condition. This should not change based on current knowledge." 
 
 More information 
 
 For more on preparing children for anesthesia, visit the American Society of Anesthesiologists. ||||| Surgical anesthesia given to children under the age of 4 years may be associated with reduced gray matter density in certain brain regions, leading to lower IQ and poorer language development. This is according to a new study by researchers from Cincinnati Children's Hospital, OH. 
 
 
 
 Children who underwent general anesthesia for surgery before the age of 4 were found to have poorer intelligence and language development. Children who underwent general anesthesia for surgery before the age of 4 were found to have poorer intelligence and language development. 
 
 Lead study author Dr. Andreas Loepke, of the Department of Anesthesiology at Cincinnati Children's, and colleagues publish their findings in the journal Pediatrics. 
 
 In past research, Dr. Loepke and colleagues found that general anesthesia led to nerve cell death and cognitive impairment in mice and rats, which sparked concern about how general anesthesia may impact the human brain in early life - a crucial neurodevelopmental period. 
 
 As such, the team set out to assess how general anesthesia given to children undergoing surgery before the age of 4 years may affect brain structure, IQ and language development. 
 
 "The ultimate goal of our laboratory and clinical research is to improve safety and outcomes in young children who have no choice but to undergo surgery with anesthesia to treat their serious health concerns," says Dr. Loepke. 
 
 "We also have to better understand to what extent anesthetics and other factors contribute to learning abnormalities in children before making drastic changes to our current practice," he adds, "which by all measures has become very safe." 
 
 Anesthesia before age 4 linked to lower gray matter density in cerebellum, occipital cortex 
 
 The researchers enrolled 53 participants aged 5-18 years who had undergone surgery involving general anesthesia before the age of 4, alongside 53 age-matched participants who had not had surgery. 
 
 None of the children had a history of neurologic or psychological illness, according to the team, and none had experienced traumatic brain injuries. 
 
 Magnetic resonance imaging (MRI) was used to analyze the children's brain structures, and the children were also required to complete IQ and language development tests, including the Oral and Written Language Scales and the Wechsler Intelligence Scale. 
 
 While all children's test scores were within the normal range in comparison with the general population, the team found that those who underwent surgery had much lower IQ and language development scores than those who had not had surgery. 
 
 What is more, the researchers found that the lower test scores among the children who underwent surgery were mediated by reduced gray matter density in the occipital cortex and cerebellum of the brain. 
 
 These findings remained after accounting for potential confounding factors, including children's age, gender, socioeconomic status, left or right handedness, the type of surgery performed and the length of exposure to anesthetics. 
 
 Lower IQ scores may equate to lifetime earnings loss of $560 billion 
 
 According to the researchers, the lower IQ scores identified among children who received general anesthesia for surgery is the equivalent to a potential loss of around a 5-6 IQ points. 
 
 They note that this finding could have important implications for society, pointing to one previous study that estimated every 1-point IQ loss may reduce a person's lifetime earnings potential by $18,000. 
 
 The researchers calculate that among the 6 million children who undergo surgery in US each year, a 5-6-point loss in IQ could equate to a potential lifetime earnings loss of $540 billion. 
 
 The team notes that their findings emphasize the importance of finding better ways to administer anesthesia to young children undergoing surgery - something they are currently investigating in laboratory studies. 
 
 However, they stress that current anesthesia techniques are very safe and that the benefits of surgery for young children far outweigh the risks associated with anesthetic exposure. 
 
 "It is important to note that no surgeries are truly elective in young children," Dr. Loepke notes. "Many surgical procedures early in life treat life-threatening conditions, avert serious health complications, or improve quality of life. These cannot be easily postponed or avoided." 
 
 In June 2014, Medical News Today reported on a study published in the Proceedings of the National Academy of Sciences, which provided insight into what happens to the human brain as it recovers from the effects of general anesthesia. 
 
 The research team - including Andrew Hudson of the University of California-Los Angeles - found that the brain has to go through a series of certain states, or "way stations," in order to recover from anesthetic. 
 
 "We found that certain states act as hubs through which the brain must pass to continue on its way to consciousness," Hudson explains. ||||| The youngest surgical patients might suffer down the road with eroded abilities to communicate and understand, according to a new study that adds weight to evidence that anesthesia can damage the developing brain. 
 
 A team at Cincinnati Children’s Hospital compared kids who had surgery before they were 4 years old with peers of the same age, gender and socioeconomic status. Their study included 106 5- to 18-year-olds who underwent assessments to measure brain development. The researchers also looked at MRI images of the children’s brains. 
 
 Surgery appeared to be associated with lower language abilities and cognition, and with lower brain mass, they reported today in the journal Pediatrics. 
 
 The study isn’t perfect: It looks back on a group of kids studied for another research project and includes a relatively small sample group. The scientists can say only that they think they’ve found an association and can’t prove that anesthesia caused the deficits. 
 
 But it provides more evidence of the importance of other work to figure out how anesthesiologists can do less potential harm during unavoidable surgical procedures on babies and children, said lead author Dr. Andreas Loepke. 
 
 All of the kids in the group had test scores that were within normal ranges, he said. But those who had operations had significantly lower scores in listening comprehension, lower IQs and less brain density in certain areas. 
 
 “These children are not dying. These effects are fairly subtle, but they’re still concerning, and that’s why I think we need to act on them,” Loepke said. 
 
 Previous research has estimated that the loss of a single IQ point can correlate with a decrease in a person’s lifetime earnings potential by $18,000. This study found a potential loss of five or six points. 
 
 The researchers pointed out that based on an estimated 6 million pediatric surgeries annually, the lifetime potential loss in earnings could be $540 billion. 
 
 Loepke said continued work in Cincinnati and elsewhere, including in Columbus, aims to provide more answers about how to make anesthesia safer for pediatric patients. 
 
 That could mean finding new anesthetics or figuring out whether some in use are safer than others. It could mean replacing general anesthesia with regional anesthesia, or discovering techniques to reverse or mitigate the damage. 
 
 “These are not elective surgeries. (The children) need the surgery,” Loepke said. “What we’re trying to figure out is how do we make anesthesia even safer.” 
 
 Dr. Emmett Whitaker, attending pediatric anesthesiologist at Nationwide Children’s Hospital, said the study is solid and gives anesthesiologists more valuable information about what previous research — most of it on rats and mice — has shown. 
 
 Whitaker said he is particularly concerned about the smaller brain volume seen in the kids who had been given anesthesia. 
 
 “If a loss of neurons is what’s occurring, that’s a big concern,” he said. 
 
 Anesthesiologists and surgeons already strive to limit the exposure a child has to anesthesia by making sure everything is ready to go when they enter the operating room. When a child must have two procedures (or a surgery and an MRI that requires sedation), they try to do them during one visit. 
 
 “We’re starting to try to identify less-toxic regimens,” Whitaker said. 
 
 Dr. Ibrahim Farid, chairman of anesthesia and pain medicine at Akron Children’s Hospital, said he is eager for results of other studies that aim to figure out whether regional anesthesia could replace general anesthesia in some operations, thereby decreasing risks to the brain. 
 
 Another study is comparing twins — one who had surgery, one who didn’t — prospectively, and that should prove enlightening as well, he said. 
 
 Previous studies point to a high-risk period around a child’s first birthday, he said, and that might mean that it makes sense to try to postpone surgeries until age 2 when possible. 
 
 Repairs to hernias and removal of extra digits or masses can often wait safely, Farid said. 
 
 mcrane@dispatch.com 
 
 @MistiCrane ||||| CINCINNATI - Children who received general anesthesia for surgery before age 4 had diminished language comprehension, lower IQ and decreased gray matter density in posterior regions of their brain, according to a new study in the journal Pediatrics. 
 
 Researchers from Cincinnati Children's Hospital Medical Center report their findings in the journal's June 8 online edition. The authors recommend additional studies to determine anesthesia's precise molecular effects on the brain and contribution to diminished brain function and composition. Researchers say this knowledge could make it possible to develop mitigating strategies for what the authors describe as a potential dilemma for child health. 
 
 "The ultimate goal of our laboratory and clinical research is to improve safety and outcomes in young children who have no choice but to undergo surgery with anesthesia to treat their serious health concerns," said Andreas Loepke, MD, PhD, FAAP, lead study author and an anesthesiologist in the Department of Anesthesiology at Cincinnati Children's. "We also have to better understand to what extent anesthetics and other factors contribute to learning abnormalities in children before making drastic changes to our current practice, which by all measures has become very safe." 
 
 Loepke and his research colleagues have published previous studies showing widespread cell death, permanent deletion of neurons and neurocognitive impairment in laboratory rats and mice after exposure to general anesthesia. Those studies have raised concerns about similar effects in young children during a particularly sensitive neurodevelopmental period in early life, which researchers say could interfere with the refinement of neuronal networks and lead to long-term functional abnormalities. 
 
 For their current retrospective study, the authors compared the scores of 53 healthy participants of a language development study (ages 5 to 18 years with no history of surgery) with the scores of 53 children in the same age range who had undergone surgery before the age of 4. 
 
 The authors stress that average test scores for all 106 children in the study were within population norms, regardless of surgical history. Still, compared with children who had not undergone surgery, children exposed to anesthesia scored significantly lower in listening comprehension and performance IQ. Researchers also report that decreased language and IQ scores were associated with lower gray matter density in the occipital cortex and cerebellum of the brain. 
 
 Researchers, who used extensive analysis of surgical and other medical records, said the children were matched for age, gender, handedness and socioeconomic status - all confounding factors of cognition and brain structure. The authors also factored into their calculations the types of surgeries and length of exposure to anesthetics. The anesthetics used during the surgeries included common agents such as sevoflurane, isoflurane or halothane (used alone or in combination) and nitrous oxide. 
 
 Children included in the study did not have a history of neurologic or psychological illness, head trauma or any other associated conditions. Neurocognitive assessments included the Oral and Written Language Scales and the Wechsler Intelligence Scale. Brain structural comparisons were conducted by MRI scans. 
 
 Estimated Social Cost 
 
 Extending their study a step beyond the medical data, the research team also considered the potential societal impact of their findings. Earlier research from 2008 had estimated the loss of 1 IQ point to decrease a person's lifetime earnings potential by $18,000. Factoring in the potential loss of 5 or 6 IQ points found in their current study, the researchers report that, based on the estimated 6 million children who undergo surgery in the United States each year the lifetime potential earnings loss could total $540 billion. 
 
 Emphasis on Safety 
 
 Although data in the current study highlight the need to look for improved methods of administering anesthesia, Loepke and his colleagues emphasize that current methods are very safe. Loepke advises parents who are concerned to discuss with their pediatrician and surgeon the risks of a surgical procedure - and the potential risk of anesthetic exposure - versus the risks of not having a surgery. 
 
 "It is important to note that no surgeries are truly elective in young children," Loepke said. "Many surgical procedures early in life treat life-threatening conditions, avert serious health complications, or improve quality of life. These cannot be easily postponed or avoided." 
 
 Loepke also stressed that researchers at Cincinnati Children's are actively looking for alternative anesthetic techniques in their ongoing laboratory studies. Drugs are being tested that show potential for lessening the harmful effects of anesthetics in laboratory rats and mice, and this research is ongoing. Additionally, the medical center is participating in an international clinical trial to test an alternative anesthetic regimen in young children undergoing urological procedures. 
 
 ### 
 
 Collaborating on the current study were: the first author, Barynia Backelijauw, BS, currently a medical student at the University of Cincinnati College of Medicine (UC); Scott Holland, PhD., Imaging Research Center-Division of Radiology at Cincinnati Children's and Mekibib Altaye, PhD., Division of Biostatistics/Epidemiology at Cincinnati Children's. Drs. Loepke, Holland and Altaye are on faculty at the UC. 
 
 Funding support came in part from the National Institute of Child Health and Human Development (R01HD38578); the University of Cincinnati Research, Observation, Service and Education Student and Summer Undergraduate Research Fellowship Programs, and from departmental funds of the Department of Anesthesiology, Cincinnati Children's. 
 
 About Cincinnati Children's:
– A new study out of the University of Cincinnati suggests that kids who need general anesthesia before the age of 4 might suffer the consequences years later with lower IQs. In the study published in Pediatrics, researchers looked at 106 kids ages 5 to 18, half of whom had surgery before their fourth birthday, reports Medical News Today. Generally speaking, the kids who had been under anesthesia scored worse on intelligence tests and in listening comprehension, and they had less gray matter in two areas of the brain (the cerebellum and occipital cortex), reports HealthDay News. All of the kids in the study were still in the normal range for IQs, but the researchers found that the anesthesia kids consistently scored about 5 or 6 points lower. "The very receptors that anesthetics act on to produce unconsciousness during surgery are also important for stimulating neurons to form proper connections and to survive," says study author Andreas Loepke. "Anesthetic exposure may interfere with normal brain development." In a post at Eureka Alert, the team even puts a societal cost on the problem of $540 billion, based on earlier research suggesting that the loss of one IQ point translates to a lifetime earnings drop of $18,000. So what to do? These are typically unavoidable surgeries, but the study shows the importance of figuring out safer protocols for kids—maybe more regional anesthetics instead of general anesthesia, or methods to limit the damage, for example, reports the Columbus Dispatch. (A previous study looked at the scary-sounding problem of people waking up during surgery.)