Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For infants with exposure to general anesthesia who may have long term adverse neurodevelopmental outcome, what is the effectiveness of an alternate anesthetic technique of regional anesthesia?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

general anesthesia and regional anesthesia in infants who need surgery.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

the study will need to be conducted in two different infant populations: (1) the healthy infant population who have surgery on an elective basis and (2) critically ill infants, with significant co morbidities, who require emergent and/or urgent surgery.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

infants under 12 months of age

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

improve the long term safety outcome of anesthesia exposure

Describe any health-related risks, side effects, or harms that you are concerned about.

health related risks are developmental delay, autisim spectrum disorders, behavioral abnormalities and attention hyperactivity disorder.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Developmental delays, attention-deficit hyperactivity disorder, and autism

AHRQ Priority Populations

None

Federal Health Care Program

None

Importance

Describe why this topic is important.

More than 1.5 million infants have surgery with anesthesia annually. Therefore, any adverse effects of anesthesia exposure would have significant public health impact in a large number of patients. Strategies and interventions that could mitigate any potential long term adverse outcome in neurodevelopment would be important and relevant.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I am a pediatric anesthesiologist who takes care of infants every day and this is a question that affects my practice and is of great concern to the parents of my patients.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

This would provide the required evidence to make informed decisions for parents, anesthesiologists and policy makers in guiding the practice of anesthesia in infants in particular and young children in general.

Describe the timeframe in which an answer to your question is needed.

As soon as feasible.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Infants

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

This would provide the required evidence to make informed decisions for parents, anesthesiologists and policy makers in guiding the practice of anesthesia in infants in particular and young children in general.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program