The Relationship of Exposure to Anesthesia on Outcomes in Children With Isolated Oral Clefts

Abstract

This study evaluated the relationship between exposure to anesthesia and previously identified differences in cognitive functioning, growth, and volumetric brain measures among a sample of children, adolescents, and young adults with isolated oral clefts (iCL/P). Data from a cross-sectional study was combined with a retrospective chart review. Data was obtained for 87 participants with iCL/P (55% male), ranging from 7.5 to 27 years old (mean = 15.78 [SD = 4.58]). Measures of interest included cognitive functioning, growth measures, and brain volumes. Number of surgeries and time under anesthesia were obtained through systematic medical record review. Potential sex and cleft type differences in exposure as well as relationships between anesthesia exposure and outcome measures were evaluated. Participants with isolated cleft lip and palate had more surgeries and were under anesthesia longer. For participants with isolated cleft lip only, more surgeries were correlated to lower verbal IQ and higher frontal lobe volume.

Efficacy and Safety in Combining Primary Palatoplasty and Myringotomy in Patients with Cleft Palate

“… 19 This directly addresses patients with CLP because most of them undergo cheiloplasty and/or PP between 6 and 12 months after birth in an effort to optimize feeding and speech outcomes. 20 Conrad et al 21 found that recurrent exposure to anesthesia can result in impaired cognitive growth and frontal lobe development. Additionally, they observed that pediatric patients with an isolated cleft lip who underwent several procedures were more likely to present with decreased verbal intelligence quotient (IQ).…”

Systematic review of the neurocognitive outcomes used in studies of paediatric anaesthesia neurotoxicity

“…Investigators have used a variety of specific assessment tools, or parts hereof, to evaluate different criteria within development, cognition, intelligence, academic achievement, and neuropsychological diagnosis. Comparatively, few studies have assessed outcomes such as neuroimaging, 18,35,48,49,56,63 mortality, or serum-biomarkers. 18,19,22,38,39,42,44,48 Previously, it has been questioned which criteria are suitable outcome measures in studies on long-term neurocognitive Table 3 Risk of bias evaluation; A-I represents rating categories according to Newcastla-Ottawa Scale for assessing quality of non-randomised studies.…”

“…Comparatively, few studies have assessed outcomes such as neuroimaging, 18,35,48,49,56,63 mortality, or serum-biomarkers. 18,19,22,38,39,42,44,48 Previously, it has been questioned which criteria are suitable outcome measures in studies on long-term neurocognitive Table 3 Risk of bias evaluation; A-I represents rating categories according to Newcastla-Ottawa Scale for assessing quality of non-randomised studies. A, Representativeness of the exposed cohort; B, Selection of the non-exposed cohort; C, Ascertainment of exposure; D, Outcome of interest was not present at start of study; E, Comparability of cohorts -major factor controlled for; F, Comparability of cohorts -any additional factor controlled for; G, Assessment of outcome; H, Follow-up long enough for outcome to occur?…”

“…Glatz and colleagues 3 + + + À + + + + À Nestor and colleagues 16 + + + À + + + À + Hu and colleagues 17 + + + À + + + + + Conrad and colleagues 18 + À + + + + À + À Birajdar and colleagues 19 + À + À + À + + À Terushkin and colleagues 20 + À + À + À À À À Lap and colleagues 21 + + + À + + + + + Yazar and colleagues 22 À + À À À À + + + Sun and colleagues 2 + + + À + + + + + Seltzer and colleagues 23 + À + + + + À + + Davidson and colleagues 4 O'Leary and colleagues 24 + + + À À + + À + Djurhuus and colleagues 25 + + + À + + + + + Clausen and colleagues 75 + + + À + + + + + Poor Zamany Nejat Kermany and colleagues 26 + + + À + + À + + Hoffman and colleagues 27 À À + À + + + + À Hansen and colleagues 28 + À À À + + + + À Graham and colleagues 29 + + + À + + + À + Doberschuetz and colleagues 30 + + + À À + + + + Diaz and colleagues 31 À À + À + + À + À de Heer and colleagues 32 À + À À + + À + À Aun and colleagues 33 + + + + À + + + + Bakri and colleagues 34 + + + À À + À À + Taghon and colleagues 35 + + + À À À À + À Naguib and colleagues 36 À À + À À + À + À Ko and colleagues 37 + + + + + + + À À Hansen and colleagues 38 + + + À + + + + + Gano and colleagues 39 + + + + + + + + À Backeljauw and colleagues 40 + + + + À + + À + Petr ackov a and colleagues 41 + + + À + + + + À Yan and colleagues 42 + + + + À + + À + Yin and colleagues 43 + À + + + À + + + Morriss and colleagues 44 + + + À À + + À À Ing and colleagues 45 À + À À + + À + + Gaynor and colleagues 46 + À + À + + À + À Garcia Guerra and colleagues 47 + À + À À + + + + Cheng and colleagues 48 + À + + + + À + + Andropoulos and colleagues 49 + À + + À + + + + Ko and colleagues 50 + + + + À + + À À Minutillo and colleagues 51 + À + À + + + + + Hansen and colleagues 52 + + + À + + + + + Fan and colleagues 53 + À + + À À + + + Bong and colleagues 54 + + + À À + À + À Yang and colleagues 55 À À + + À + À À + Andropoulos and colleagues 56 À À + + + + + + À Walker and colleagues 57 + + + À À + À + + Sprung and colleagues 58 + + + À À + + + À Sananes and colleagues 59 + À + À + + + + À Rocha and colleagues 60 + À + À + À + + À Long and colleagues 61 + À + À À À + + À Long and colleagues 62 + À + À À + + + À Ing and colleagues 5 À + À À À + À + + Filan and colleagues 63 + + + À À + + + + Continued consequences following GA and surgery. 78 So far, epide...…”

Cleft lip/palate and educational attainment: cause, consequence, or correlation? A Mendelian randomization study

“…Affected children are required to take time off school to undergo surgery to repair the cleft (a study in the United States showed that roughly 24% of surgeries to repair CL and 37% of surgeries to repair CP are secondary surgeries, and roughly 70% of those occur during school ages 44 ), and to attend follow-up health assessments, which could affect their learning. There is some observational evidence that repeated surgery (and therefore repeated exposure to general anaesthesia) is associated with lower IQ in children born with a cleft 21,45 .…”