The negative effect of general anesthesia on intellectual dysfunction has previously been given little consideration in these children. Yet, anesthesia is deployed over and over again for myriad procedures, such as lumbar puncture, bone marrow sampling, and placement of central venous catheter; administration of daily radiotherapy in younger children; and years of surveillance imaging with MRI or CT. These experiences are not unique to children with medulloblastoma and brain tumors, but rather routine to other children with cancer and even some with other complex or chronic diseases. Although this study was retrospective and limited to only those anesthesia exposures in the first 12 months following medulloblastoma diagnosis, the results should be concerning to all children with complex disease, their families, and their providers. Have we gone too far in the omnipresence of anesthesia to streamline or even escalate the care of children with complex disease, or to spare them any physical pain or psychological trauma? Prospective collection of anesthesia exposure in childhood illnesses is certainly warranted, as the authors suggest, but such an effort will take many years. Perhaps here and now we should reconsider how many procedures are truly required and management-altering in pediatric patients, minimize those procedures, and ask when is anesthesia truly a must.
© 2020 Published by Elsevier Inc.