Key result
Early childhood general anesthesia was not associated with global neurodegeneration, but multiply exposed children had lower dynamic balance scores (0.3 SD lower; 95% CI 0.1-0.5; P<0.001).
Why the study?
Common anesthetic agents cause neurodegeneration in developing animal brains, prompting warnings and the hypothesis that early general anesthesia and surgery associate with adverse neurodevelopmental outcomes.
Does exposure to general anesthesia and surgery before 4 years of age reduce neurodevelopmental outcomes at age 7 to 16 years in children?
Cohort (n=13,433)
Does exposure to general anesthesia and surgery before 4 years of age reduce neurodevelopmental outcomes at age 7 to 16 years in children?
Early childhood general anesthesia and surgery were not associated with global neurodegenerative effects, but were associated with significantly lower motor and social linguistic performance.
Motor deficits after early anesthesia merit monitoring in exposed children; leaves open causality versus surgical indications.
BACKGROUND: Most common anesthetic agents have been implicated in causing neurodegeneration in the developing animal brain, leading to warnings regarding their use in children. The hypothesis of this study was that exposure to general anesthesia and surgery before 4 yr would associate with adverse neurodevelopmental outcomes at age 7 to 16 yr. METHODS: This cohort study comprised 13,433 children enrolled in the Avon Longitudinal Study of Parents and Children, a prospective, population-based birth cohort born between 1991 and 1993 in southwest England. Children were grouped by none, single, or multiple exposures to general anesthesia and surgery by 4 yr. Motor, cognitive, linguistic, educational, social, and behavioral developmental outcomes were evaluated at 7 to 16 yr using school examination results, validated parent/teacher questionnaires, or clinic assessments. Continuous outcomes were z-scored. P-value thresholds were corrected using false discovery rate procedures. RESULTS: This study compared 46 neurodevelopmental outcomes in 13,433 children: 8.3% (1,110) exposed singly and 1.6% (212) exposed multiply to general anesthesia and surgery. Of these, the following reached predefined levels of statistical significance (corrected P < 0.00652): dynamic balance scores were 0.3 SD (95% CI, 0.1, 0.5; P < 0.001) lower in multiply exposed children; manual dexterity performance was 0.1 SD (95% CI, 0.0, 0.2; P = 0.006) lower in singly and 0.3 SD (95% CI, 0.1, 0.4; P < 0.001) lower in multiply exposed children; and social communication scores were 0.1 SD (95% CI, 0.0, 0.2; P = 0.001) and 0.4 SD (95% CI, 0.3, 0.5; P < 0.001) lower in singly and multiply exposed children, respectively. General anesthesia and surgery were not associated with impairments in the remaining neurodevelopmental measures including: general cognitive ability; attention; working memory; reading, spelling, verbal comprehension and expression; behavioral difficulties; or national English, mathematics, and science assessments (all ≤0.1 SD; corrected P ≥ 0.00652). CONCLUSIONS: Early childhood general anesthesia and surgery were not associated with a global picture of clinically and statistically significant neurodegenerative effects, providing reassurance about the neurotoxic potential of general anesthesia. Exposure to anesthesia and surgery was associated with significantly lower motor and social linguistic performance.
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Walkden et al. (2020) conducted a cohort in Neurodevelopment in children (n=13,433). General anesthesia and surgery before 4 years of age vs. No exposure to general anesthesia and surgery by 4 years of age was evaluated on 46 neurodevelopmental outcomes including motor, cognitive, linguistic, educational, social, and behavioral development. Early childhood general anesthesia was not associated with global neurodegeneration, but multiply exposed children had lower dynamic balance scores (0.3 SD lower; 95% CI 0.1-0.5; P<0.001).
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