Our Summary

This research paper discusses the possible harmful effects of certain anesthetics on the developing brain of unborn babies and young children. Studies have shown that exposure to these drugs can potentially lead to loss of brain cells and impaired brain function. In 2016, the US Food and Drug Administration (FDA) issued a warning about this risk, specifically related to the anesthetics isoflurane, sevoflurane, desflurane, propofol, and midazolam.

The FDA suggests that health professionals should carefully weigh the benefits and risks of using these anesthetics in young children and pregnant women, especially in procedures that last over 3 hours or when multiple procedures are required in children under 3 years old.

The paper emphasizes that these concerns may affect how anesthesia and surgery are managed in pregnant patients. While general anesthesia is not commonly used during cesarean delivery, the fetus can still be exposed to these drugs during non-obstetrical or fetal surgery in the second and third trimester.

The authors suggest some strategies to decrease potential harm, including using alternative sedatives, minimizing exposure to harmful anesthetics, and reducing the time between the start of anesthesia and the surgery to decrease exposure.

In conclusion, the type of anesthesia used and the potential risks should be carefully considered when scheduling pregnant patients for non-obstetrical and fetal surgery.

FAQs

  1. What harmful effects can certain anesthetics have on the developing brain of unborn babies and young children?
  2. What are the anesthetics that the FDA issued a warning about in 2016?
  3. What strategies are suggested to decrease the potential harm of anesthetics on the developing brain of unborn babies and young children?

Doctor’s Tip

A doctor may advise a patient undergoing brain surgery to follow post-operative care instructions carefully, including getting plenty of rest, staying hydrated, taking medications as prescribed, and attending follow-up appointments. They may also recommend avoiding strenuous activities, heavy lifting, and driving until cleared by their healthcare provider. Additionally, the doctor may stress the importance of maintaining a healthy lifestyle, including regular exercise, a balanced diet, and managing stress to support optimal recovery and overall brain health.

Suitable For

Patients who are typically recommended brain surgery include those with:

  1. Brain tumors: Surgery may be necessary to remove a tumor or relieve pressure on the brain caused by the tumor.

  2. Traumatic brain injury: Surgery may be needed to repair damaged tissue or reduce swelling in the brain after a head injury.

  3. Hydrocephalus: Surgery may be necessary to implant a shunt to drain excess fluid from the brain.

  4. Epilepsy: Surgery may be recommended for patients with severe epilepsy that does not respond to medication.

  5. Aneurysms or other vascular malformations: Surgery may be necessary to repair or remove abnormal blood vessels in the brain.

  6. Parkinson’s disease or other movement disorders: Surgery may be recommended for patients who do not respond to medication or other treatments.

  7. Chiari malformation: Surgery may be necessary to relieve pressure on the spinal cord caused by a congenital malformation.

  8. Intractable pain: Surgery may be recommended for patients with chronic pain that does not respond to other treatments.

It is important for patients to discuss the risks and benefits of brain surgery with their healthcare provider to determine if it is the best course of treatment for their specific condition.

Timeline

Before brain surgery, a patient typically undergoes a series of pre-operative appointments and tests to assess their overall health and determine the best course of action for the surgery. This may include blood tests, imaging scans, and consultations with various healthcare providers. The patient will also be instructed on how to prepare for the surgery, such as fasting before the procedure.

During the surgery, the patient is put under general anesthesia, which puts them into a sleep-like state and prevents them from feeling any pain during the procedure. The surgeon then makes an incision in the scalp and removes part of the skull to access the brain. The surgery itself can vary depending on the reason for the procedure, such as removing a tumor, repairing an aneurysm, or treating epilepsy.

After the surgery, the patient is typically monitored closely in the intensive care unit (ICU) or a specialized neurosurgical unit. They may experience side effects such as headaches, nausea, vomiting, and fatigue. Pain medication may be prescribed to manage any discomfort. Physical and occupational therapy may also be recommended to help the patient regain strength and function.

In the weeks and months following brain surgery, the patient will have follow-up appointments with their healthcare team to monitor their recovery and address any concerns or complications. Rehabilitation may be recommended to help the patient regain cognitive function, motor skills, and speech abilities. The patient and their loved ones will also receive guidance on how to manage any long-term effects of the surgery and how to support the patient in their ongoing recovery journey.

What to Ask Your Doctor

Some questions a patient should ask their doctor about brain surgery include:

  1. What are the potential risks and complications associated with the surgery?
  2. What is the success rate of this type of brain surgery?
  3. How long will the recovery process take and what can I expect during this time?
  4. Are there any alternative treatment options available for my condition?
  5. What is the experience and expertise of the surgical team performing the procedure?
  6. Will I need to undergo any additional tests or procedures before the surgery?
  7. What is the expected outcome of the surgery and what are the potential long-term effects?
  8. What is the plan for pain management after the surgery?
  9. How will the anesthesia be administered during the surgery?
  10. Are there any specific precautions or considerations I should be aware of before the surgery?

It is important for patients to have a clear understanding of the risks, benefits, and expectations associated with brain surgery in order to make informed decisions about their treatment.

Reference

Authors: Olutoye OA, Baker BW, Belfort MA, Olutoye OO. Journal: Am J Obstet Gynecol. 2018 Jan;218(1):98-102. doi: 10.1016/j.ajog.2017.08.107. Epub 2017 Sep 6. PMID: 28888583