Consequences of General Anesthesia in Infancy on Behavior and Brain Structure

Salaün, Jean‐Philippe; Chagnot, Audrey; Cachia, Arnaud; Poirel, Nicolas; Datin-Dorrière, Valérie; Dujarrier, Cléo; Lemarchand, Eloïse; Rolland, Marine; Delalande, Lisa; Gressèns, Pierre; Guillois, B.; Houdé, Olivier; Levard, Damien; Gakuba, Clément; Moyon, Marine; Naveau, Mikaël; Orliac, François; Orliaguet, Gilles; Hanouz, Jean‐Luc; Agin, Véronique; Vivien, Denis

doi:10.1213/ane.0000000000006233

Cited by 5 publications

(3 citation statements)

References 45 publications

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“…The use of imaging studies as a biomarker has, therefore, become an appealing alternative. One recent study evaluated MRI assessments as well as neuropsychological outcomes in a cohort of 102 children, of which 24 had been exposed to anesthesia [ 5 ▪ ]. The anesthetic exposed children were found to have lower levels of gray matter volume in the right interior frontal gyrus as well as worse emotional control scores.…”

Section: Does Anesthesia Cause Neurotoxicity In Humans?mentioning

confidence: 99%

Unanswered questions of anesthesia neurotoxicity in the developing brain

Ing

Vutskits

2023

Current Opinion in Anaesthesiology

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Purpose of review This article reviews recent advances and controversies of developmental anesthesia neurotoxicity research with a special focus on the unanswered questions in the field both from clinical and preclinical perspectives. Recent findings Observational cohort studies of prenatal and early childhood exposure to anesthesia have reported mixed evidence of an association with impaired neurodevelopment. Meta-analyses of currently available studies of early childhood exposure to anesthesia suggest that, while limited to no change in general intelligence can be detected, more subtle deficits in specific neurodevelopmental domains including behavior and executive function may be seen. Several studies have evaluated intraoperative blood pressure values and neurocognitive outcomes and have not found an association. Although many animal studies have been performed, taking into consideration other peri-operative exposures such as pain and inflammation may help with translation of results from animal models to humans. Summary Advances have been made in the field of developmental anesthetic neurotoxicity over the past few years, including the recognition that anesthetic exposure is associated with deficits in certain cognitive domains but not others. Although the most important question of whether anesthetic agents actually cause long-term neurodevelopmental effects in children has still not been answered, results from recent studies will guide further studies necessary to inform clinical decision-making in children.

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Section: Does Anesthesia Cause Neurotoxicity In Humans?mentioning

confidence: 99%

Unanswered questions of anesthesia neurotoxicity in the developing brain

Ing

Vutskits

2023

Current Opinion in Anaesthesiology

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show abstract

“…Notably, we had reported that children exposed to GA early, before age three, had a small association with an increased risk of developmental delay after that [ 30 ]. Furthermore, in an animal study exposed to postnatal GA, adult mice have chronically exacerbated fear behavior, associated with an 11% reduction of the periaqueductal gray matte compared to the non-GA group [ 31 ]. In addition, it is shown that multiple sevoflurane exposures induced remarkable learning ability impairment in younger but not adult mice involved in the function of Egr2, a critical protein for age-dependent vulnerability to sevoflurane-induced cognitive deficits [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

General Anesthesia in Early Childhood Significantly Reduces Asthma Incidence and Clinical Visits: A Nationwide Population-Based Cohort Study

Yang

Chang

et al. 2023

Children

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Few studies have focused on the consequence of exposure to general anesthesia (GA) in children’s early life with the risk of asthma and disease outcomes. The present study examines the correlation between exposure to GA under three years old and the subsequent course of asthma in a nationwide population-based cohort study. Our cases were acquired from Taiwan’s National Health Insurance Research Database (NHIRD). Children under three years old with either GA exposure or not during in-patient treatment from 1997 to 2008 were included. The study group was age- and sex-matched with a ratio of 1:2 to create the control group for comparison. The cohort included 2261 cases with GA and 4522 cases without GA as a control group. The incidence of asthma onset was significantly reduced in patients with GA exposure under 3 three years old (hazard ratio 0.64 (95% confidence interval 0.57~0.72), p < 0.001). In addition, regardless of whether the asthmatic clinical visits were before or after GA exposure, asthma onset patients before GA exposure have significantly fewer clinical visits than those without GA exposure (both p < 0.001, respectively). Using the Kaplan–Meier method, we also demonstrated that GA exposure was associated with favorable clinical visits in patients with asthma, whether their asthma was onset before GA (p = 0.0102) or after GA exposure (p = 0.0418) compared to non-GA-exposed controls. In the present study, we demonstrated that children with early GA exposure under three years old were at a reduced risk of developing asthma compared to the general population. Furthermore, we first reported that GA exposure significantly reduced clinical visits in patients with asthma regardless of whether their asthma onset was before or after GA exposure. It is indicated that GA exposure at a younger age could have potential clinical benefits for asthma than non-GA-exposed controls.

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“…In this issue, a bold effort is made to link the impact of anesthetic exposure on neonatal mice to the outcomes of anesthetic exposure in a cohort of young children. 1 In the preclinical portion of the study, neonatal mice had multiple exposures to isoflurane anesthesia, and at 6 to 8 weeks, they had assessments of motor, emotional, and cognitive functions and volumetric brain magnetic resonance imaging (MRI). The APprentissages EXécutifs et cerveau chez les enfants d’âge scolaire (APEX) is an ongoing project that investigates the impact of computerized executive training program for children and adolescents on executive functioning by neurobehavioral testing and the prefrontal cortex size by MRI.…”

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confidence: 99%