How does this affect development?
We all hope the children we care for never have to endure surgery and that they’re perfectly healthy. But what happens when questions come up about anesthesia? Whether they’re undergoing dental work or something very serious, it’s important to know and understand the implications of the drugs used. This is especially a concern for those children on the autism spectrum or with developmental delays. It’s widely known that children with these delays have abnormal detoxification systems, therefore, medications can be more harmful than studies have shown them to be. This can even hold true for neurotypical children.
The typical anesthesia provider’s job is to make the experience as smooth as possible. In doing so, the detoxification and metabolic issues at hand may not be accounted for or the individual may have little to no experience with these issues. When a child has abnormal detoxification or metabolic issues, these affect the anesthetic choice and the outcome long term.
There have been many reports from parents that their child regressed developmentally post-anesthesia and this points to a toxic insult. These insults must be minimized. A study done by Wilder (Anesthesiology April 2005) reported from 5,000 children born they found one exposure to anesthesia (halothane and nitrous oxide) was not harmful, yet, more than one exposure between birth and the age of four more than doubled the risk that a child would be diagnosed with a learning disability by age 19.
Unfortunately, there’s no single medication that can handle amnesia, analgesia, and muscle relaxation. This why several medications are used in the anesthesia process. Here’s a short list of the most common anesthetics used:
- Versed (Midazolam)- Considered reasonably safe, short acting, not heavily metabolized. Used for sedation, amnesia and anti-anxiety.
- Fentanyl (Sublimaze) – Short acting and not heavily metabolized.
- Propofol– short acting agent designed to keep the child asleep. Warning: contains soy and egg; possible exacerbating drug for those with mitochondrial disease.
- Sevoflurane (Ultane) – Just 2-5% of it is metabolized making this a great choice.
- Ketamine (Ketalar) – An hallucinogenic used for short-term minor procedures (i.e., burns), doesn’t supress respirations like others. Warning: alters sensory perception, which raises concerns for kids with sensory processing disorders (SPD) or symptoms of SPD.
- Nitrous oxide – Readily used at dentist. Warning: can be neurotoxic, may cause neuropathy, difficult for the liver to metabolize, may be a problem for those children with underlying B12 or folate problems, often given with sevoflurane to allow the child to fall asleep faster but together they increase the concentration of one another, which may be harmful. You can read more about more about nitrous from Selzer, et al. and Baum, VC who published studies in 2003 and 2007, respectively.
We know methylation is important for detoxification, myelin sheath formation, neurotransmitters, and DNA synthesis. So any child with a methylation issue needs to be very cautious.
Things for parents to consider prior to surgery:
1. Do testing prior to surgery to check for any deficiencies.
2. Skip the Nitrous oxide because many kids have a documented B12 deficiency.
3. Consider placement of an IV without sedation to cut down on medication use.
4. Inform the anesthesiologist of all supplements, medications and IgE allergies.
5. Make sure that you meet with the anesthesiologist ahead of time and that they understand your challenges and/or concerns.
6. Ask for them to keep the anesthetics as simple as possible. Let them know about the detoxification concerns. For example, you don’t need three different drugs for nausea. Taking fluids post surgery to prevent dehydration and vomiting is the avenue you want to take to avoid nausea.
Supplement options which you may wish to consider to aid with detoxification are: Activated charcoal; methyl B12; epsom salt baths; ion-cleanse cellular detoxification bath; milk thistle; antioxidants – Vitamins A, C, E; magnesium; glutathione; and phosphatidyl choline.