An Assessment of the Effects of General Anesthetics on Developing Brain Structure and Neurocognitive Function

Loepke, Andreas W.; Soriano, Sulpicio G.

doi:10.1213/ane.0b013e318167ad77

Cited by 414 publications

(271 citation statements)

References 139 publications

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“…Neurodegeneration caused by common anesthetic agents in developing brain structures has been documented in several animal models (28). Although the applicability of animal data to clinical anesthesia practice remains uncertain, worries remain, that subtle but prolonged changes in behavior, including learning impairment, could result after general anesthesia in early infancy.…”

Section: Discussionmentioning

confidence: 99%

Is there an ideal age for hypospadias repair? A pilot study

Weber

Schönbucher

Gobet

et al. 2009

Journal of Pediatric Urology

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Objective:The aim of this study is to assess whether repairing hypospadias before or after 18 months affects psychological adjustment, health-related quality of life (HRQoL) and surgical outcome. Subjects/Patients77 boys with a current age of 6 to 17 years were assigned to two groups, according to whether they had a hypospadias repair before or after the age of 18 months. The surgical outcome was assessed with the Pediatric Penile Perception Score by non involved urologists. A psychologist interviewed the patients to assess HRQoL and gender-role behavior. The child's psychological adjustment was assessed with a questionnaire for parents. ResultsThe surgical outcome and complication rate were not significantly different. A covariance analysis of HRQoL, gender-role behavior and psychological adjustment as a function of age at the last operation with current age as covariant was performed, but differences did not reach significance. ConclusionThis study cannot provide evidence to support recommendations concerning the ideal age for hypospadias repair. In the absence of evidence of a benefit of early surgery, anesthesia related risk factors must be considered when operating in very early infancy.2 Large, prospective studies, measuring surgical and psychological outcome with similar instruments to those presented may reveal whether there is a truly ideal age for hypospadias surgery. KeywordsHypospadias, surgery, outcome assessment, psychosexual development, gender-role behaviour, health related quality of life

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Section: Discussionmentioning

confidence: 99%

Is there an ideal age for hypospadias repair? A pilot study

Weber

Schönbucher

Gobet

et al. 2009

Journal of Pediatric Urology

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“…42 Repeated general anesthesia in children may cause detrimental neurocognitive effects, based on animal and preclinical studies, although this remains an area of controversy. [48][49][50] New technologies, such as MCGRs that obviate surgical lengthenings, will probably help minimize the total number of exposures to anesthesia in EOS.…”

Section: Complications Of Distraction-based Implantsmentioning

confidence: 99%

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

et al. 2016

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Early-onset scoliosis (EOS) is defined as curvature of the spine in children >10° with onset before age 10 years. Young children with EOS are at risk for impaired pulmonary function because of the high risk of progressive spinal deformity and thoracic constraints during a critical time of lung development. The treatment of EOS is very challenging because the population is inhomogeneous, often medically complex, and often needs multiple surgeries. In the past, early spinal fusion was performed in children with severe progressive EOS, which corrected scoliosis but limited spine and thoracic growth and resulted in poor pulmonary outcomes. The current goal in treatment of EOS is to maximize growth of the spine and thorax by controlling the spinal deformity, with the aim of promoting normal lung development and pulmonary function. Bracing and casting may improve on the natural history of progression of spinal deformity and are often used to delay surgical intervention or in some cases obviate surgery. Recent advances in surgical implants and techniques have led to the development of growth-friendly implants, which have replaced early spine fusion as the surgical treatment of choice. Treatment with growth-friendly implants usually requires multiple surgeries and is associated with frequent complications. However, growth-friendly spine surgery has been shown to correct spinal deformity while allowing growth of the spine and subsequently lung growth.

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“…[1][2][3][4][5] N-methyl-D-aspartate antagonists (such as nitrous oxide and ketamine) and g-aminobutyric acid agonists (such as benzodiazepines, propofol, and volatile anesthetics) are thought to mediate these apoptotic effects. 6,7 In the animal model, long-term neurocognitive changes, including differences in learning, memory, motor activity, attention, and behavior during adulthood, have also been identified. 3,[8][9][10] A window of vulnerability in rodents appearstooccurduringpeaksynaptogenesis between postnatal day 7 and 30.…”

mentioning

confidence: 99%

Long-term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia

Ing¹,

DiMaggio

Whitehouse³

et al. 2012

Pediatrics

558

408

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BACKGROUND: Over the past decade, the safety of anesthetic agents in children has been questioned after the discovery that immature animals exposed to anesthesia display apoptotic neurodegeneration and long-term cognitive deficiencies. We examined the association between exposure to anesthesia in children under age 3 and outcomes in language, cognitive function, motor skills, and behavior at age 10. METHODS: We performed an analysis of the Western Australian Pregnancy Cohort (Raine) Study, which includes 2868 children born from 1989 to 1992. Of 2608 children assessed, 321 were exposed to anesthesia before age 3, and 2287 were unexposed. RESULTS: On average, exposed children had lower scores than their unexposed peers in receptive and expressive language (Clinical Evaluation of Language Fundamentals: Receptive [CELF-R] and Expressive [CELF-E]) and cognition (Colored Progressive Matrices [CPM]). After adjustment for demographic characteristics, exposure to anesthesia was associated with increased risk of disability in language (CELF-R: adjusted risk ratio [aRR], 1.87; 95% confidence interval [CI], 1.20–2.93, CELF-E: aRR, 1.72; 95% CI, 1.12–2.64), and cognition (CPM: aRR, 1.69; 95% CI, 1.13–2.53). An increased aRR for disability in language and cognition persisted even with a single exposure to anesthesia (CELF-R aRR, 2.41; 95% CI, 1.40–4.17, and CPM aRR, 1.73; 95% CI, 1.04–2.88). CONCLUSIONS: Our results indicate that the association between anesthesia and neuropsychological outcome may be confined to specific domains. Children in our cohort exposed to anesthesia before age 3 had a higher relative risk of language and abstract reasoning deficits at age 10 than unexposed children.

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An Assessment of the Effects of General Anesthetics on Developing Brain Structure and Neurocognitive Function

Cited by 414 publications

References 139 publications

Is there an ideal age for hypospadias repair? A pilot study

Is there an ideal age for hypospadias repair? A pilot study

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

Long-term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia

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