Association Between Exposure to General Anesthesia and Cognitive and Behavioral Changes in Children Under 6 Years of Age, Undergoing Urogenital Surgery: Prospective Study

Objective: Longitudinal studies investigating alterations in cognitive functions and behavioral patterns after general anesthesia (GA) exposure remain scarce. The present study aimed to examine whether exposure to GA agent before the age of 6 is associated with adverse effects on these outcomes. Material and Methods: Eligible children aged 2-6 years who were scheduled to undergo urogenital surgery were recruited. Denver Developmental Screening Test, 2nd edition (DDST Ⅱ) was administered before the operation and 6 months after surgery. The Child Adjustment and Parent Efficacy Scale (CAPES), which evaluates adaptation and behavioral problems as well as parental self-efficacy, was also used. Of the initial sample, 18 children who completed the DDST Ⅱ and the scales at both assessments constituted the study group. Results: The median age of the participants (18) was 54 months (mean=50.45, standard deviation=17.1), and all were male. Scores on the CAPES-behavioral problems (t=-1.243, p=0.214) and CAPES-emotional problems (t=-1.119, p=0.263) subscales were higher at the 6-month post-operative assessment than baseline, whereas scores on the parental self-efficacy subscale (t=-1.586, p=0.113) were lower. No significant difference was found between the DDST II results at 2 occasions. When the study group was subdivided based on a history of previous GA exposure; at 6- month postoperatively, children with multiple exposures showed significantly higher rates of risk for gross motor (p=0.034) and personal-social (p=0.034) developmental delays than those with a single exposure. Conclusion: Our findings suggest a possible association between multiple GA exposures and increased risk of delays in specific developmental domains, warranting further investigation in larger cohorts.