Comparative Analysis of Outcome Measures Used in Examining Neurodevelopmental Effects of Early Childhood Anesthesia Exposure

Abstract

When assessing cognition in children with early exposure to anesthesia, the results may depend on the outcome measure used. Neuropsychological and International Classification of Diseases, 9th Revision, Clinical Modification-coded clinical outcomes showed an increased risk of deficit in exposed children compared with that in unexposed children, whereas academic achievement scores did not. This may explain some of the variation in the literature and underscores the importance of the outcome measures when interpreting studies of cognitive function.

Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia

“…22 This finding seems to confirm that individually administered neurocognitive tests may be more sensitive for determining a potential neurologic phenotype after anesthetic exposure. 23 Moreover, the present results extend the earlier observation of lower performance IQ in preschool-aged children with congenital heart disease after early life exposure to anesthesia and sedation 24 to healthy school-aged children and adolescents, with potentially greater prognostic importance for subsequent performance in adulthood. Although our study surprisingly demonstrated a larger effect size after a comparatively briefer exposure, these 2 studies are difficult to compare because of their substantial differences in comorbidity, acuity of surgery, age during and duration of exposure, and, importantly, control of confounders (eg, parental socioeconomic status and education).…”

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

“…While these results do not prove a direct link between early anesthesia exposure, most often provided to tolerate surgery, and long-term behavioral consequences in humans, they suggest that emotional consequences should be analyzed in future clinical studies that aim to identify long-term outcomes of infant anesthesia. Most recent studies, including the Pediatric Anesthesia Neurodevelopment Assessment (PANDA) and General Anaesthesia compared to Spinal anesthesia (GAS) studies, focus on cognitive function and intellectual performance (language skills, IQ) as the primary outcome measures (e.g., [46][47][48][49]; few have examined other functional outcomes, such as socioemotional development. Further, future experimental research in primates should aim to identify the mechanisms responsible for the behavioral consequences of infant anesthesia exposure in order to develop safe anesthesia regimes or protective strategies for young children requiring surgical or diagnostic interventions.…”

Is a short anesthetic exposure in children safe? Time will tell: a focused commentary of the GAS and PANDA trials

“…th Edition, Clinical Modification (ICD-9) diagnoses at subsequent clinical visits (25,26). The authors found a strong association between early anesthesia and language and cognition deficits on the neuropsychological tests and corresponding ICD-9 codes, but no significant correlation with achievement tests.…”