Associations between the Duration of General Anesthesia Exposure and Attention Deficit Hyperactivity Disorder (ADHD) as well as Behavioral Problems

Abstract

Background: The potential relationship between early exposure to general anesthesia and the risk of developing attention deficit hyperactivity disorder (ADHD) has not been determined. Methods: This retrospective cohort study included children who were exposed to general anesthesia before the age of 3 during 2017–2020. The participants were divided into two groups: 1 (< 3 hours of exposure) and 2 (≥ 3 hours of exposure). Children not exposed to general anesthesia were recruited into the unexposed group. The Conners' Parent Symptom Questionnaire (PSQ) was used to assess ADHD incidence. Linear regression analysis was used to assess the association between the duration of general anesthesia exposure and ADHD, as well as different dimensions. Results:The incidences of ADHD were 4.0%, 8.1%, and 14.7% in the three groups. The duration of anesthesia was significantly associated with the risk of ADHD, regardless of whether the duration of anesthesia was treated as a continuous variable (odds ratio (OR): 0.077, 95% confidence interval (CI): 0.024–0.130, p=0.011) or as a dichotomous variable (OR: 2.544, 95% CI: 1.318–4.910, p=0.005) between the unexposed group and the exposed 2-year-old group. In addition, the results showed that the duration of anesthesia may be significantly associated with adverse learning problems and impulsivity-hyperactivity (ptrend=0.023; p trend=0.005, respectively). According to the subgroup analysis of sex, the risk of ADHD differed significantly between the unexposed group and the exposed 2 group among male children (OR=3.185, 95% CI=1.101–9.217, p=0.031). Conclusions: This study highlights the significant association between longer anesthesia exposure (≥3 hours) and the risk of ADHD, particularly in male children.