Are Anesthesia and Surgery during Infancy Associated with Altered Academic Performance during Childhood?

Abstract

Background: Although studies in neonatal animals show that anesthetics have neurotoxic effects, relevant human evidence is limited. We examined whether children who had surgery during infancy showed deficits in academic achievement. Methods: We attempted to contact parents of 577 children who, during infancy, had one of three operations typically performed in otherwise healthy children. We compared scores on academic achievement tests with population norms. Results: Composite scores were available for 287 patients. The mean normal curve equivalent score was 43.0 Ϯ 22.4 (mean Ϯ SD), lower than the expected normative value of 50, P Ͻ 0.0001 by one-sample Student t test; and 35 (12%) had scores below the 5th percentile, more than expected, P Ͻ 0.00001 by binomial test. Of 133 patients who consented to participate so that their scores could be examined in relation to their medical records, the mean score was 45.9 Ϯ 22.9, P ϭ 0.0411; and 15 (11%) scored below the 5th percentile, P ϭ 0.0039. Of 58 patients whose medical records showed no central nervous system problems/potential risk factors during infancy, 8 (14%) scored below the 5th percentile, P ϭ 0.008; however, the mean score, 47.6 Ϯ 23.4, was not significantly lower than expected, P ϭ 0.441. Duration of anesthesia and surgery correlated negatively with scores (r ϭ Ϫ0.34, N ϭ 58, P ϭ 0.0101).

Anesthesia and Apoptosis in the Developing Brain: An Update

“…However, after correcting for sex, birth weight, parental and maternal age, and education, there was no difference in the academic performance between those exposed and unexposed to anesthesia (-0.04, 95 % CI: -z0.09 to 0.01). In a smaller but similar study using school records in the state of Iowa, USA, researchers examined children who had undergone surgery in infancy and who had no other risk factors for neurobehavioral delay [46]. The mean of their school test scores was similar to the population average; however, the exposed cohort did have a higher percentage of children who scored below the fifth centile.…”

Effects of Long-Duration Administration of 1% Isoflurane on Resting Cerebral Blood Flow and Default Mode Network in Macaque Monkeys

“…Also, it has been demonstrated that the duration of anesthesia is one of the risk factors for early postoperative cognitive dysfunction (Moller et al, 1998), and the duration of general anesthesia is associated with the risk of cell death in the developing brains (McCann and Soriano, 2012). Meanwhile, it has been reported that an increased risk for neurobehavioral disturbances correlates positively with the duration of anesthesia exposure (Block et al, 2012;Wilder et al, 2009). Animal studies have further demonstrated that spatial memory was impaired for 2 weeks after long-duration administration of isoflurane in aged rats (Culley et al, 2004) and isoflurane might cause brain cell death, neurocognitive decline in immature rats (Stratmann et al, 2010).…”

“…In addition, neurobehavioral disturbances and cognitive decline have been reported in patients post-anesthesia (Block et al, 2012;Flick et al, 2011;Sprung et al, 2012;Wilder et al, 2009). As the cerebral physiology closely correlates with the neural activation and cognitive performance in the brain, it is important to examine the duration effects of isoflurane on CBF and brain functionality when subjects are anesthetized.…”

Isoflurane Anesthesia Has Long-term Consequences on Motor and Behavioral Development in Infant Rhesus Macaques

“…Several retrospective human studies of neurocognitive and behavioral disorders following childhood exposure to anesthesia suggest a similar association; results indicate that the effects may be more profound with repeated general anesthetic events, longer anesthesia duration, [6][7][8][9] or cumulative exposures to multiple types of anesthetics, independent of comorbidities. 10,11 Moreover, repeated anesthetic exposure has been associated with an increased risk for the development of attention deficit hyperactivity disorder (ADHD) later in life. 12 It is less clear whether a single anesthetic exposure, particularly of short duration, is enough to trigger long-term sequelae in young children.…”