Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort

Abstract

Background Exposure of young animals to general anesthesia causes neurodegeneration and lasting behavioral abnormalities; whether these findings translate to children remains unclear. This study used a population-based birth cohort to test the hypothesis that multiple, but not single, exposures to procedures requiring general anesthesia before age 3 yr are associated with adverse neurodevelopmental outcomes. Methods A retrospective study cohort was assembled from children born in Olmsted County, Minnesota, from 1996 to 2000 (inclusive). Propensity matching selected children exposed and not exposed to general anesthesia before age 3 yr. Outcomes ascertained via medical and school records included learning disabilities, attention-deficit/hyperactivity disorder, and group-administered ability and achievement tests. Analysis methods included proportional hazard regression models and mixed linear models. Results For the 116 multiply exposed, 457 singly exposed, and 463 unexposed children analyzed, multiple, but not single, exposures were associated with an increased frequency of both learning disabilities and attention-deficit/hyperactivity disorder (hazard ratio for learning disabilities = 2.17 [95% CI, 1.32 to 3.59], unexposed as reference). Multiple exposures were associated with decreases in both cognitive ability and academic achievement. Single exposures were associated with modest decreases in reading and language achievement but not cognitive ability. Conclusions These findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention. Although a robust association was observed, these data do not determine whether anesthesia per se is causal.

Assessing the Surgical Experience to Identify Risk Factors Associated with Severe Retinopathy of Prematurity and Laser Intervention

“…Infants who required laser intervention underwent more surgical interventions, implying that there may be a cumulative effect of surgery similar to the cumulative effect of anesthesia described in the literature [21]. Intraoperative FiO2 of infants receiving laser intervention was lower than those who did not.…”

The hydra of anesthetic neurotoxicity: Myth or reality?

“…In fact, in the study by Graham et al, the association was entirely accounted for by the older children in the cohort. The concern regarding multiple anesthetic exposure and increased risk for a diagnosis of learning disabilities, consistently reported by the Mayo clinic group, was also not confirmed in these large cohort studies. Discordant results may reflect differences in patient selection or outcomes chosen, but concern regarding confounding persists.…”

Anesthetics and Cognitive Impairments in Developing Children

“…Current clinical findings show a robust association between an early exposure to anesthesia and learning disabilities/behavioral impairments later in life, 7–9 in particular when the exposure was prolonged and/or repeated. For example, in a cohort of 1036 patients, anesthesia exposure lasting more than a couple of hours or multiple exposures occurring before age 3 years resulted in a higher propensity for developing learning disabilities and attention-deficit/hyperactivity disorder.…”

“…7 In particular, multiple exposures were associated with decreased cognitive ability and academic achievement, whereas single exposures were associated with modest decreases in reading and language achievement but not cognitive ability. 7 A retrospective study looking at otherwise healthy children who were exposed to anesthesia before age 1 year reported that about 12% to 14% performed below the fifth percentile on academic achievement tests compared with the population as a whole (about 5%). 8 The study suggests a direct correlation between the length of exposure and learning disabilities (ie, the longer the duration of anesthesia, the lower the scores on academic achievement tests), but the authors caution that there may be explanations other than anesthesia exposure.…”