Patterns of neuropsychological changes after general anaesthesia in young children: secondary analysis of the Mayo Anesthesia Safety in Kids study

Abstract

Background: We hypothesised that exposure to multiple, but not single, procedures requiring general anaesthesia before age 3 yr is associated with a specific pattern of deficits in processing speed and fine motor skills. Methods: A secondary analysis (using factor and cluster analyses) of data from the Mayo Anesthesia Safety in Kids study was conducted, in which unexposed, singly exposed, and multiply exposed children born in Olmsted County, MN, USA from 1994 to 2007 were sampled using a propensity-guided approach and underwent neuropsychological testing at ages 8e12 or 15e20 yr. Results: In the factor analysis, the data were well fit to a five factor model. For subjects multiply (but not singly) exposed to anaesthesia, a factor reflecting motor skills, visual-motor integration, and processing speed was significantly lower [standardised difference of e0.35 (95% confidence interval {CI} e0.57 to e0.13)] compared with unexposed subjects. No other factor was associated with exposure. Three groups were identified in the cluster analysis, with 106 subjects (10.6%) in Cluster A (lowest performance in most tests), 557 (55.9%) in Cluster B, and 334 (33.5%) in Cluster C (highest performance in most tests). The odds of multiply exposed children belonging to Cluster A was 2.83 (95% CI: 1.49e5.35; P¼0.001) compared with belonging to Cluster B; there was no other significant association between exposure status and cluster membership. Conclusions: Multiple, but not single, exposures to procedures requiring general anaesthesia before age 3 yr are associated with a specific pattern of deficits in neuropsychological tests. Factors predicting which children develop the most pronounced deficits remain unknown.

Laminin degradation by matrix metalloproteinase 9 promotes ketamine‐induced neuronal apoptosis in the early developing rat retina

“…Although the risk of learning and memory impairments associated with general anesthesia in children is still under debate, parents and the general public are very concerned about the safety and long-term outcome of children undergoing general anesthesia. 1,2 Furthermore, various animal studies have demonstrated that long-term or repeated exposure to general anesthetics can cause neuronal apoptosis in early stages of life and learning and memory impairments later in life. [3][4][5] General anesthesia-induced neurotoxicity in animals mainly occurs during the period of peak synaptogenesis, referred to as the window of vulnerability.…”

General Anesthetic-Induced Neurotoxicity in the Immature Brain: Reevaluating the Confounding Factors in the Preclinical Studies

“…As the Chinese proverb says "every medicine has its side effect." Newly published data, extracted from the MASK study and analyzed by factor and cluster analyses, showed that multiple exposures to general anesthesia before the age of 3 years were associated with specific deficits in neuropsychological tests [92].…”

A review of the management of single-suture craniosynostosis, past, present, and future

“…71 Additionally, single exposures are less associated with neuropsychological deficits, whereas multiple exposures are associated with a modest decrease in processing speed and fine-motor coordination. 71,77 Parents also reported that children multiply exposed to anesthesia have more difficulties with behavior and reading. Based on these findings, we would predict that in the first year of life infants undergoing a shorter-duration endoscopic approach with a single anesthesia exposure would be less vulnerable to neurocognitive decline than those undergoing longer and more extensive cranial vault reconstruction or techniques that require a second anesthetic.…”