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Wednesday, June 19, 2013
One or Several Procedures with Anesthesia?
My 6 year old son is severely disabled. He has had 5 anesthesias since birth. He now needs anesthesia for 3 procedures : - checking his retina (very high myopia and does not dilate with atropine, his eye doctor can only check properly if sedated) - putting a fourth set of grommets(and possibly removing the adenoids) and doing ABR tests for his hearing aids - dental treatment (as cannot be examined (xray) and treated for his cavities when awake)
Should I try to organise all the 3 procedures under the same anesthesia or should he have several anesthesia (if so, how long apart) ?
Thanks in advance to help me decide.
Extra question : Since this may have to be done regularly during his life : is there a limit on total numbers of anesthesia ?
Doing all the procedures at the same time would be the ideal, but that is often difficult to arrange. There is no recognized limit to the number of anesthetics that a person should have over a lifetime. Each anesthetic may pose some (usually small) risk but the risk does not increase each time with greater numbers of anesthetics, unless the person becomes generally sicker. There has been some controversy lately over whether children, and the elderly, may suffer prolonged, harmful cognitive (thinking) effects after anesthesia. There does seem to be increased vulnerability to this at the extremes of age, but it is not clear how much of the effect is due to the surgery, and how much due to the anesthesia. For children, those under the age of 5 seem to be most at risk. On the other hand, there is no way for your son to have these procedures done without anesthesia, and clearly they are all of importance to his health and wellbeing. In that context, any small risk of the anesthesia, whether in one, two or three sessions, is probably well worth it.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University