For more than 20 years, Robert Williams, M.D., has contended that spinal anesthesia – which can be used for such common early childhood surgical procedures as hernia repair and circumcision – is better for babies than general anesthesia.
Now, the University of Vermont pediatric anesthesiologist has additional confirmation from three recent studies, which, combined with his own team’s research, could have a significant impact on the more than one million U.S. children younger than five that annually undergo surgery requiring anesthesia.
One study, published in Anesthesiology in May 2015, concluded that infants were less likely to experience a common post-surgical problem for infants called apnea (pauses in breathing) in the first 30 minutes after surgery if they had “awake regional” anesthesia. This is typically delivered via a spinal injection that locally numbs the region below the abdomen, rather than knocks out the patient.
That study’s lead author, Andrew Davidson, M.D., of Royal Children’s Hospital in Australia, called the spinal option “safer” than general anesthesia.
“That was a very strong statement,” Williams says, adding that he has maintained a low-key approach to his pro-spinal anesthesia efforts.
A related study by the same group, also published in Anesthesiology, calculated a nearly 90 percent success rate with the spinal technique, with no need for additional forms of sedation. “And with training and experience, you would only expect the success rates to go higher and approximate our 97 percent success rate,” Williams says.
A third study, published this month in Pediatrics, found that children younger than four years old who received general anesthesia during surgery had lower IQs, decreased language skills and less density as seen on MRI scanning in some parts of their brains compared with those who never had surgery or anesthesia. That research, led by anesthesiologists at Cincinnati Children’s Hospital Medical Center, reinforced previous studies in baby animals that raised concerns about the consequences of general anesthesia on developing brains.
“We still don’t understand exactly the potential risk general anesthesia may post to young brains,” Williams says. “However, in those cases where we can do a spinal, we can just take the concerns with general anesthesia off the table.”
He is among the world’s principal pioneers in the use of spinal injection for young children. Continuing the earlier work of UVM Professor of Anesthesiology Emeritus J. Christian Abajian, M.D., Williams has found that children experience a lower incidence of apnea, less likelihood of a drop in blood pressure and fewer respiratory events after surgery with the spinal injection.
To Williams, it’s not only the scientific evidence that supports his argument; the faces of wide-awake infants during surgery tell him all he needs to know, he says.
“No monitor replaces looking at the baby, holding their hands and watching that baby suck on a pacifier” during a procedure, Williams says, displaying a photo of a child with a pacifier in his mouth, laying undisturbed while surgeons work below a drape across his belly. “That’s the best monitor I can have of a kid.”
The two related studies led by researchers in Australia involved 722 children younger than 14 months who underwent surgery at 28 institutions – including the University of Vermont Medical Center – and randomly received either spinal or general anesthesia. These patients are part of an ongoing project known as GAS, or general anesthesia compared with spinal, to assess the effects on intelligence and neurological development at ages two and five.
Williams is continuing to pursue his own study, comparing the educational records of children who have received spinal anesthesia at UVM with those who have received general anesthesia at Dartmouth-Hitchcock Medical Center in New Hampshire. He hopes all the information will help raise awareness among parents, who are the key to opening the door to more use of the spinal technique.
“Parents have always been concerned when their baby has to undergo general anesthesia,” he says. “Here in Vermont, parents are clearly relieved when we tell them there is an alternative to general anesthesia. I want parents all around the world to know that’s an option for the right cases.”
Read more about Williams’ research here.