December FY23

[kristenhorsman]

This month's article is presented by Aileen Mendez. She chose an article that explores exposure to anesthesia in childhood and the subsequent use of Attention Deficit Hyperactivity Disorder medication. You will find the article here.

Please answer the following two questions:

1. Which surgical procedures were referenced in the article? What procedures would you consider “elective” for children vs. those which are necessary?

2. What % of children were needing of ADHD medication after 1 anesthetic exposure before age 5?

[sjsimmons]

1. This article explores the association between persistent ADHD medication use and exposure to anesthesia for pyloromyotomy, inguinal hernia repair, circumcisions outside the perinatal period, and tonsillectomy and/or adenoidectomy. One could argue that all of these procedures could be considered necessary rather than elective. A pyloromyotomy is necessary to correct dehydration and electrolyte abnormalities, an inguinal hernia repair is necessary to prevent incarcerated or strangulated hernias, a T&A may be necessary in cases of persistent infection or severe obstruction causing health and behavioral problems, and a circumcision may be necessary in cases of tight foreskin or recurrent infection.

2. According to this article, children in all age groups exposed to anesthesia for one of the surgical procedures listed above were found to have a 37% increased risk of persistent ADHD medication use when compared to unexposed children. Although the patient population in this longitudinal study included children before age 5, I would be curious to see research on this topic extended beyond 5 years of age. According to the CDC, the average age of diagnosis is 7 years old.

[Soo-Ok Kim]

This is the great article in the light of increasing interest in any cognitive/behavioral impairment associated anesthesia exposure. Thank you for presenting this article, Aileen.

1. Which surgical procedures were referenced in the article? What procedures would you consider “elective” for children vs. those which are necessary?
Pyloromyotomy, inguinal hernia repair, T&A,circumcisions. I would consider these are not purely elective since those unrepaired medical problem can lead to short/long term negative health consequences.

2. What % of children were needing of ADHD medication after 1 anesthetic exposure before age 5?
The exposure to anesthesia in those age group, based on this article, has 37% increased risk of persistent ADHD medication use compared to unexposed children.

[Anne McNulty]

This article assessed the association between a single exposure to anesthesia before age 5 years. The population of the study is children enrolled in Texas and New York Medicaid from 1999 to 2010.The cases referenced pyloromyotomy, inguinal hernia repair, circumcisions (outside the perinatal period ) and tonsillectomy and/or adenoidectomy. All of these cases can become necessary depending on the presenting circumstances. (2) Thirty seven per cent of children in this study had risk of persistent ADHD medication use compared to unexposed children. This study needs to include children that are not Medicaid patients and a broader geographical region that Texas and New York state.

[kels]

1.Pyloromyotomy, inguinal hernia repair, tonsillectomy and or adenoidectomy, circumcisions. All of these procedures can be considered necessary

2. 37%

[Amy Swank]

1. T And A, circumcisions, inguinal hernia repair, pylormyotomy, depending on the patient and situation would determine whether it is necessary vs elective.
2. 37% had risk of needing ADHD medication after exposure to anesthetic. Interesting since needing a T and A in childhood with OSA also has a high incidence of the child developing ADHD later in childhood.

[Jennifer Hannon]

1. Which surgical procedures were referenced in the article? What procedures would you consider “elective” for children vs. those which are necessary?
I ranked them in order of necessity to possibly elective based on the patient: Pyloromyotomy, inguinal hernia repair, T&A, circumcisions.

2. What % of children were needing of ADHD medication after 1 anesthetic exposure before age 5?
Based on this article, Children exposed to 1 anesthetic before age 5 have a 37% increased risk of persistent ADHD medication use compared to unexposed children.

[Wai-Ling Lo]

1. Pyloromyotomy, T&A, inguinal hernia repair, circumcision. I too think that it really depends on the presentation of the patient to determine whether those surgeries are urgent vs necessary versus elective. For example pyloromyotomy can be urgent if the patient is symptomatic from the pyloric stenosis.

2. per this article, 37% increased risk

[aileenm4]

Hi all thank you for the great replies, most of surgeries in peds are necessary, unlikely to be elective, however to play devils advocate, pylomotomy is a medical emergency and not a surgical emergency, in some European countries, children are placed on TPN till they grow out of the stenosis and no surgery is done. Circumcisions are mostly done for asthetics and desires of parents, we often hold off on newborn circs when the babies are too ill to have them at birth and they come back when older to have them done: T&A these days are mostly done for OSA which can lead to a host of problems related to poor sleep. Its a very interesting topic and more studies need to be done, another area of research and studies is that hypotension maybe a contributer.

[christine velarde]

1, Exposure to anesthesia for pyloromyotomy, T and A, inguinal hernia repair and circumcision were surgeries that data was collected. I thing that the data was collected from medicaid patients and the article pointed out that medicaid patients may be exposed to other toxins, envionmental exposure.
2 The article suggests 37& increase. I think another population should be studied to see if there is a definate correlation for ADHAD and exposure to anesthesia.