The effects of brief sevoflurane‐nitrous oxide anaesthesia upon children's postoperative cognition and behaviour

Abstract

This study assessed the effects of brief sevoflurane-nitrous oxide anaesthesia on children's postoperative cognition, behaviour and physical morbidity. Forty-eight children aged 5-10 years undergoing anaesthesia without premedication for multiple dental extractions, and 48 control children, performed tests of choice reaction time, attention, psychomotor co-ordination and memory pre-operatively (baseline), prior to discharge and at 48 h (anaesthesia group only). Physical and psychological morbidity were recorded at 1 week. Mean choice reaction time and psychomotor co-ordination were significantly impaired postoperatively but had recovered at 48 h. However, measures of performance variability suggested the presence of residual impairment. Profound retrograde amnesia affected postoperative and 48-h recall of pictorial stimuli presented prior to anaesthesia, but recognition memory was unimpaired. Attention-seeking, tantrums, crying and nightmares were occurring more frequently in some 8-20% of children 1 week after the procedure.

Decreased PSD95 expression in medial prefrontal cortex (mPFC) was associated with cognitive impairment induced by sevoflurane anesthesia

“…Cognitive function is one of the most basic and important high-level neurological functions in the brain, and it is a basic indicator of the development of human intelligence. Supporting our result, many previous studies also reported the effect of sevoflurane, as well as other anesthetics, on cognitive function (Chen et al, 2001;Millar et al, 2006;Peng et al, 2011;Gong et al, 2012). Interestingly, Peng et al (2011) found that exposure to 1.5% sevoflurane, for as long as 3 d (2 h/d), did not cause significantly different cognitive performance, while exposure to 3% sevoflurane for 2 h was enough to induce cognitive impairment.…”

The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

“…36 However, the children in this sample were not undergoing ordinary elective surgical procedures; instead they had been referred for this radical treatment on account of their poor dental condition, toothache and likely pre-existing dental anxiety. 6,37 The fact that the population in the present study had preoperative total Rutter scores approaching the previously validated indicator for clinically signifi cant 'disturbance' is evidence of their poor preoperative behavioural and emotional state. Despite parental agreement to continue to attend for dental follow-up, the results in this regard were disappointing, though not surprising given the previous dental history and social deprivation scores of the sample.…”

“…A previous controlled study, on the same population though different recruits, confi rmed that children self-reported signifi cantly higher levels of dental anxiety postoperatively 6 …”

Interdisciplinary research: the importance of learning other people’s language

“…One of the best current examples of interdisciplinary work in which I am involved brings together dental surgeons, anaesthetists, psychologists and a statistician on a succession of projects about the effects of general anaesthesia and other forms of sedation on the physical and cognitive behaviour of young children, see Millar et al (2006). With a group of scientists from very different disciplines, learning to talk one another's language is very important.…”