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13-10-2011 | Surgery | Article

Alarm raised over infant anesthesia exposure


Free abstract

MedWire News: Multiple exposures to general anesthesia before the age of 2 years may harm children's cognitive development, research suggests.

The study was a matched cohort design, involving 350 children, identified from a birth cohort, who were exposed to general anesthesia and surgery before the age of 2 years, and 700 unexposed children who were matched to the exposed children for known factors for learning disabilities.

The researchers say only that they "cannot exclude" an adverse effect of anesthesia exposure on children's cognitive development, and also point out that the children, who were born between 1976 and 1982, were mostly exposed to halothane, which is no longer in widespread use.

"In general, this study should not alter decision-making related to surgery in young children," cautioned lead researcher Randall Flick (Mayo Clinic, Rochester, Minnesota, USA), in a press statement.

"We do not yet have sufficient information to prompt a change in practice and want to avoid problems that may occur as a result of delaying needed procedures. For example, delaying ear surgery for children with repeated ear infections might cause hearing problems that could create learning difficulties later in school."

Flick and team report, in the journal Pediatrics, that 81 of the exposed and 138 unexposed children developed a learning disability before the age of 19 years - for reading, mathematics, or writing. Of the children exposed to general anesthesia for surgery, 64 were exposed more than once. The overall cumulative incidences of learning disabilities at the age of 19 years were 21.3% for unexposed children, 23.6% for those with one exposure to general anesthesia and surgery, and 36.6% for those with multiple exposures.

Children with multiple exposures had double the likelihood of having learning disabilities, relative to unexposed controls, even after accounting for American Society of Anesthesiologists Physical Status and morbidity clusters based on criteria including duration of care, severity, diagnostic certainty, etiology, and need for subspecialty care.

The findings were similar when reading, mathematics, and writing learning disabilities were analyzed separately. A single exposure to anesthesia did not raise children's risk for any outcome.

Children's scores on group-administered achievement and ability tests (at about the age of 12 years) were also affected by anesthesia exposure, with those with multiple exposures having poorer total cognitive, memory, and mathematics scores than unexposed children.

Anesthesia exposure did not appear to affect behavioral outcomes, with exposed children no more likely than unexposed children to require an individualized educational program for emotional or behavioral concerns.

As well as anesthetic drugs having changed since the children in the study underwent surgery, the researchers note that surgical techniques and monitoring practices have changed.

"It is also possible that the observed effects result from effects other than those related to anesthesia including hypoxia, hyperoxia, or hypocapnia associated with monitoring that was less comprehensive than used currently (eg, pulse oximetry)," they suggest.

By Eleanor McDermid

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