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doi: 10.1097/ALN.0b013e3181c0d930

The Need for Perspective

Raghunathan, Karthik M.D., M.P.H.*; Schwartz, Donald A. M.D.; Connelly, Neil Roy M.D.

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To the Editor:—

We were disappointed that Anesthesiology chose to publish the articles by Kalkman et al.1 and Wilder et al.2 without an accompanying cautionary editorial. Kalkman et al.1 state, “children undergoing urologic surgery at age less than 24 months showed more behavioral disturbances . . . although the results were not statistically significant.” We disagree with this statement; namely, because statistical significance was not achieved, more behavioral disturbances were not observed. Furthermore, they go on to perform a sample size calculation to determine the number of patients that would be required to detect a statistically significant effect of the effect size they found. Their estimate for such a potential association between anesthesia and behavioral problems could be explained by chance alone, and using such an estimate to guide future studies is misleading. Wilder et al.2 were unable to separate out the effects of multiple anesthetics from the effects of the underlying clinical problems requiring multiple procedures. By publishing these two studies as part of a larger series including several animal models, Anesthesiology seems to send the message that two independent teams reported similar findings in humans. At a minimum, a cautionary editorial putting these studies into context was warranted. Studies such as these, reported on by the lay media, may cause an already wary public much alarm and put pediatric anesthesiologists in an impossible position. Parental concerns regarding the possible deleterious effects of anesthesia will not be assuaged by statistical explanations. Anesthesiology has an obligation beyond merely reporting interesting studies. We are sure that, like us, other readers are looking for perspective.
Karthik Raghunathan, M.D., M.P.H.,*
Donald A. Schwartz, M.D.
Neil Roy Connelly, M.D.
*Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts.
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1. Wilder RT, Flick RP, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, Gleich SJ, Schroeder DR, Weaver AL, Warner DO: Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology 2009; 110:796–804

2. Kalkman CJ, Peelen L, Moons KG, Veenhuizen M, Bruens M, Sinnema G, de Jong TP: Behavior and development in children and age at the time of first anesthetic exposure. Anesthesiology 2009; 110:805–12

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