Perioperative Medicine  |   August 2017
Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort
Author Notes
  • From the Departments of Anesthesiology and Perioperative Medicine (D.H., R.P.F., S.L.B., S.J.G., R.T.W., J.S., D.O.W.), Psychology (M.J.Z., R.C.C.), and Health Sciences Research (S.K.K., D.R.S., A.C.H.), Mayo Clinic, Rochester, Minnesota.
  • Deceased.
    Deceased.×
  • Corresponding article on page 209.
    Corresponding article on page 209.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication November 1, 2016. Accepted for publication March 16, 2017.
    Submitted for publication November 1, 2016. Accepted for publication March 16, 2017.×
  • Address correspondence to Dr. Warner: Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905. warner.david@mayo.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Pediatric Anesthesia
Perioperative Medicine   |   August 2017
Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort
Anesthesiology 8 2017, Vol.127, 227-240. doi:10.1097/ALN.0000000000001735
Anesthesiology 8 2017, Vol.127, 227-240. doi:10.1097/ALN.0000000000001735
Abstract

Background: Exposure of young animals to general anesthesia causes neurodegeneration and lasting behavioral abnormalities; whether these findings translate to children remains unclear. This study used a population-based birth cohort to test the hypothesis that multiple, but not single, exposures to procedures requiring general anesthesia before age 3 yr are associated with adverse neurodevelopmental outcomes.

Methods: A retrospective study cohort was assembled from children born in Olmsted County, Minnesota, from 1996 to 2000 (inclusive). Propensity matching selected children exposed and not exposed to general anesthesia before age 3 yr. Outcomes ascertained via medical and school records included learning disabilities, attention-deficit/hyperactivity disorder, and group-administered ability and achievement tests. Analysis methods included proportional hazard regression models and mixed linear models.

Results: For the 116 multiply exposed, 457 singly exposed, and 463 unexposed children analyzed, multiple, but not single, exposures were associated with an increased frequency of both learning disabilities and attention-deficit/hyperactivity disorder (hazard ratio for learning disabilities = 2.17 [95% CI, 1.32 to 3.59], unexposed as reference). Multiple exposures were associated with decreases in both cognitive ability and academic achievement. Single exposures were associated with modest decreases in reading and language achievement but not cognitive ability.

Conclusions: These findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention. Although a robust association was observed, these data do not determine whether anesthesia per se is causal.