Associations between the Duration of General Anesthesia Exposure and Attention Deficit Hyperactivity Disorder (ADHD) as well as Behavioral Problems

Abstract Background: The potential relationship between early exposure to general anesthesia and the risk of developing attention deficit hyperactivity disorder (ADHD) has not been determined. Methods: This retrospective cohort study included children who were exposed to general anesthesia before the age of 3 during 2017–2020. The participants were divided into two groups: 1 (Results:The incidences of ADHD were 4.0%, 8.1%, and 14.7% in the three groups. The duration of anesthesia was significantly associated with the risk of ADHD, regardless of whether the duration of anesthesia was treated as a continuous variable (odds ratio (OR): 0.077, 95% confidence interval (CI): 0.024–0.130, p=0.011) or as a dichotomous variable (OR: 2.544, 95% CI: 1.318–4.910, p=0.005) between the unexposed group and the exposed 2-year-old group. In addition, the results showed that the duration of anesthesia may be significantly associated with adverse learning problems and impulsivity-hyperactivity (ptrend=0.023; p trend=0.005, respectively). According to the subgroup analysis of sex, the risk of ADHD differed significantly between the unexposed group and the exposed 2 group among male children (OR=3.185, 95% CI=1.101–9.217, p=0.031). Conclusions: This study highlights the significant association between longer anesthesia exposure (≥3 hours) and the risk of ADHD, particularly in male children.