Cognitive and behavioral outcomes after early exposure to anesthesia and surgery

Published: October 3, 2011
Category: Bibliography > Papers
Authors: Colligan RC, Flick RP, Katusic SK, Olson MD, Sprung J, Voigt RG, Wilder RT
Countries: United States
Types: Population Health
Settings: Academic

Pediatrics 128:e1053-e1061. Erratum in: Pediatrics. 2012 Mar;129(3):595.

Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN, USA

BACKGROUND: Annually, millions of children are exposed to anesthetic agents that cause apoptotic neurodegeneration in immature animals. To explore the possible significance of these findings in children, we investigated the association between exposure to anesthesia and subsequent (1) learning disabilities (LDs), (2) receipt of an individualized education program for an emotional/behavior disorder (IEP-EBD), and (3) scores of group-administered achievement tests.

METHODS: This was a matched cohort study in which children (N = 8548) born between January 1, 1976, and December 31, 1982, in Rochester, Minnesota, were the source of cases and controls. Those exposed to anesthesia (n = 350) before the age of 2 were matched to unexposed controls (n = 700) on the basis of known risk factors for LDs. Multivariable analysis adjusted for the burden of illness, and outcomes including LDs, receipt of an IEP-EBD, and the results of group-administered tests of cognition and achievement were outcomes.

RESULTS: Exposure to multiple, but not single, anesthetic/surgery significantly increased the risk of developing LDs (hazard ratio: 2.12 [95% confidence interval: 1.26-3.54]), even when accounting for health status. A similar pattern was observed for decrements in group-administered tests of achievement and cognition. However, exposure did not affect the rate of children receiving an individualized education program.

CONCLUSIONS: Repeated exposure to anesthesia and surgery before the age of 2 was a significant independent risk factor for the later development of LDs but not the need for educational interventions related to emotion/behavior. We cannot exclude the possibility that multiple exposures to anesthesia/surgery at an early age may adversely affect human neurodevelopment with lasting consequence.

Comment in The pediatrician and anesthesia neurotoxicity. [Pediatrics. 2011]

PMID: 21969289
PMCID: PMC3307194

Age,Medications,Outcome Measures,Predictive Risk Models,United States,Age Distribution,Age of Onset,Anesthesia/methods,Case-Control Studies,Child,Preschool,Child Behavior Disorders/epidemiology,Cognition Disorders/epidemiology,Confidence Intervals,Developmental Disabilities/epidemiology,Developmental Disabilities/etiology,Gender,Follow-Up Studies,Incidence,Learning Disorders/epidemiology,Proportional Hazards Models,Reference Values,Retrospective Studies,Risk Assessment,Sex Distribution,Surgical Procedures,Operative/methods

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