Anesthesia On the Brain
Posted by on August 13, 2013 - 10:33am

New research is surfacing that links anesthesia to inhibited cognitive developments in children under four. Significant brain development occurs in young children at this time, and ketamine—a common anesthetic—has been shown to affect the brain’s learning ability. Studies began back in 2003 when Merle Paule, Ph.D., director of the Division of Neurotoxicology at the FDA’s National Center for Toxicological Research, began observing the effects of ketamine on young rhesus monkeys, since this species closely resembles humans in physiology and behavior. While the ketamine-exposed monkeys performed cognitive experiments less accurately than the control group, the affect of ketamine on human children requires further research.

Interest in this area grew so much that, in 2010, the FDA and the International Anesthesia Research Society founded an initiative called Strategies for Mitigating Anesthesia-Related neuroToxicity in Tots, or “SmartTots” for short.  Director of Anesthesia, Analgesia and Addiction Products at FDA, Bob Rappaport, M.D. said, “Our hope is that research funded through SmartTots will help us design the safest anesthetic regimens possible.” SmartTots continues to advocate for research that can protect the millions of children who receive anesthesia each year.

Supplemental studies are necessary to understand whether all forms of anesthetics elicit similar deficits as ketamine, and, if so, how long these deficits last. Columbia University and the University of Iowa are currently exploring the effects of anesthesia on infant brain development and cognitive and language ability, thanks to the funding from SmartTots.  Until more conclusive data is published, parents are urged to work closely with their child’s clinicians in weighing all options and risks before exposing young children to anesthesia.

Click here to read more on this issue.

 

Public Comment Invited on Review of Nitrous Oxide for Labor Pain Relief
Posted by on November 17, 2010 - 12:48pm

The following blog was posted on the Our Bodies Ourselves Blog and we felt it may be of interest to some of our followers.
Posted: 11 Nov 2010 08:28 AM PST
Many of you may already be familiar with the systematic and comparative effectiveness reviews produced by the Agency for Healthcare Research and Quality (AHRQ), such as these reviews of the available evidence for birth-related interventions such as labor induction, maternal request c-section, VBAC, and episiotomy.

Recently, AHRQ has become more active in soliciting public input to the review process, and today they posted for public comment the key questions and background materials for a review that will be conducted soon, Comparative Effectiveness of Nitrous Oxide for the Management of Labor Pain.

Nitrous oxide is commonly available to women for labor pain relief in many other countries, but is almost completely unavailable as an option for women in the United States. The comparative effectiveness review on this topic will examine the available evidence and look at specific questions such as its effectiveness, adverse effects, effects on women’s satisfaction with their birth experience and pain management, and health system factors influencing whether nitrous oxide is available to women who would like that option.

The public is invited to comment on this list of key questions to be addressed by the review, and can also review some background information describing the current use of nitrous oxide in the United States, the nature of the available literature, and the outcomes the review will examine.
Public comment is being accepted through December 8, 2010 via this online form; the site also provides a document to download and submit by mail if you prefer.

This project is of particular interest to me because of my work with the AHRQ Evidence-based Practice Center conducting this review. I have been involved with this topic in its preliminary stages by helping to examine the literature and writing up background information to inform the feasibility and potential impact of a full comparative effectiveness review. I will continue to be involved with the project team when the full review begins, and of course will update here when the review is completed and released.

For additional discussion of nitrous oxide for labor pain relief, please see our 2008 post with guest commentary from Judith Rooks, who has been advocating for expanded access to this choice for U.S. women.