Cognitive Outcome After Spinal Anesthesia and Surgery During Infancy

Abstract

0.1% without serious sequelae. Next, reported local anesthetic doses ranged between 0.49 and 2.29 mg/kg bupivacaine equivalents. This represents a nearly 5-fold variability in clinical practice, and these higher doses could be associated with local anesthetic toxicity. Future investigations are needed to determine optimal local anesthetic doses and indications for TAP blocks in pediatric patients. Comment by Christopher Stemland, MD Disclosure: The author declares no conflict of interest. REFERENCES 1. Sahin L, Sahin M, Gul R, et al. Ultrasound-guided transversus abdominis plane block in children: a randomized comparison with wound infiltration. Eur J Anaesthesiol. 2013;30:409-414. 2. Fredrickson MJ, Paine C, Hamill J. Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after paediatric inguinal surgery: a prospective randomized trial.S tudies on the neurotoxicity of pediatric anesthesia have been confounded by the inability to separate the need for surgery and any influence of the procedure from the effects of general anesthesia (GA). Spinal anesthesia (SA) is an alternative to GA, and its use in children may help in understanding the potential risk of neurotoxicity of GA. A recent study on elementary school children who had received a single GA during the first year of life found an association in otherwise healthy children between the duration of anesthesia and lower test scores and some with "very poor academic achievement" (VPAA), which was a score less than the fifth percentile on standardized testing. The current study was undertaken to explore the relationship of exposure to SA and surgery to later performance on standardized testing in elementary school.A combined medical and educational database was constructed from the Vermont Infant Spinal Registry (VISR) and the education information maintained by the Vermont Department of Education (VDOE). Data from the VISR database included patient gender, gestational age, postconceptual age at time of surgery, birth weight, weight at time of surgery, and type of surgery (inguinal hernia repair, pyloromotomy, and circumcision). The deidentification of the VDOE data allowed extraction of test results and a student's need for an individual education plan (IEP). A DIMER (deidentified, integrated medical and educational research) database was constructed by combining medical data with education data from the VDOE, all performed at the VDOE offices. Vermont Department of Education matched the names and dates of birth of the patient cohort with preexisting student identification. After matching, an identification number was assigned to the children, and all identifiers were removed from the data to ensure confidentiality. The DIMER database was then used for all analyses. A control cohort of children matched with the exposed population was created by grade, gender, need for free/reduced school lunch (as indicator of socioeconomic status), and year of examination. Three controls were created for each exposed subject. The prima...

Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia

“…In order to control for several confounders of neurodevelopment, we used a matched-control design, which assigned previously exposed children with control subjects based on gender, age, handedness, and socioeconomic status. 43 We found that anesthetic exposure for surgery early in life did not lead to measurable neuronal elimination in brain regions previously identified in animals. However, language comprehension and performance IQ were decreased in exposed children, compared with their unexposed controls, and these functional abnormalities were associated with decreased gray matter volume, primarily in posterior brain regions.…”

Fundamentals and innovations in regional anaesthesia for infants and children

“…Williams et al. reported that infants receiving spinal anaesthesia did not have increased odds of poor academic achievement later in life [33]. Accordingly, spinal anaesthesia was the control arm of the largest prospective study examining the effect of general anaesthesia on neurodevelopment [27, 28].…”

Cognitive Dysfunction in Children with Heart Disease: The Role of Anesthesia and Sedation

“…[34][35][36] Weaknesses are inherent in large, retrospective studies looking for a rare or hard-to-detect effect using administrative data, single-center data, and data from birth cohorts. [37][38][39][40] Large datasets have been criticized for lacking detailed information about the anesthetic and surgery and being unable to control for the effects of migration patterns, comorbidity, and educational experience. 40,41 Data from a single center may have more detailed information about the anesthetic, but are weakened by small study size.…”