Newly Published
Perioperative Medicine  |   August 2017
Are Anesthesia and Surgery during Infancy Associated with Decreased White Matter Integrity and Volume During Childhood?
Author Notes
  • From the Departments of Anesthesia (R.I.B., E.O.B., J.Y.C., J.J.T., K.K.K.), Radiology (V.A.M.), and Psychiatry (V.A.M.), Roy J. and Lucille A. Carver College of Medicine, and Department of Biomedical Engineering, College of Engineering (V.A.M.), and Department of Biostatistics, College of Public Health (E.O.B.), University of Iowa, Iowa City, Iowa. Current affiliation: Department of Anesthesiology, Medical School, University of Minnesota, Minneapolis, Minnesota (J.J.T.).
  • 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 September 8, 2016. Accepted for publication June 29, 2017.
    Submitted for publication September 8, 2016. Accepted for publication June 29, 2017.×
  • Acknowledgments: The authors thank Peggy C. Nopoulos, M.D., Daniel S. O’Leary, Ph.D., and Jatin G. Vaidya, Ph.D., Department of Psychiatry, University of Iowa (Iowa City, Iowa); Daniel J. Bonthius, M.D., Ph.D., Department of Pediatrics, University of Iowa (Iowa City, Iowa); and Michael M. Todd, M.D., Department of Anesthesiology, University of Minnesota, (Minneapolis, Minnesota), for advice concerning study design, image analyses, and/or interpretation of results.
    Acknowledgments: The authors thank Peggy C. Nopoulos, M.D., Daniel S. O’Leary, Ph.D., and Jatin G. Vaidya, Ph.D., Department of Psychiatry, University of Iowa (Iowa City, Iowa); Daniel J. Bonthius, M.D., Ph.D., Department of Pediatrics, University of Iowa (Iowa City, Iowa); and Michael M. Todd, M.D., Department of Anesthesiology, University of Minnesota, (Minneapolis, Minnesota), for advice concerning study design, image analyses, and/or interpretation of results.×
  • Research Support: Supported by SmartTots (San Francisco, California) and Department of Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa (Iowa City, Iowa).
    Research Support: Supported by SmartTots (San Francisco, California) and Department of Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa (Iowa City, Iowa).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Block: Anesthesia Research, Westlawn Building, Room 5140, University of Iowa, Iowa City, Iowa 52242. robert-block@uiowa.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 / Central and Peripheral Nervous Systems / Pediatric Anesthesia
Perioperative Medicine   |   August 2017
Are Anesthesia and Surgery during Infancy Associated with Decreased White Matter Integrity and Volume During Childhood?
Anesthesiology Newly Published on August 24, 2017. doi:10.1097/ALN.0000000000001808
Anesthesiology Newly Published on August 24, 2017. doi:10.1097/ALN.0000000000001808
Abstract

Background: Anesthetics have neurotoxic effects in neonatal animals. Relevant human evidence is limited. We sought such evidence in a structural neuroimaging study.

Methods: Two groups of children underwent structural magnetic resonance imaging: patients who, during infancy, had one of four operations commonly performed in otherwise healthy children and comparable, nonexposed control subjects. Total and regional brain tissue composition and volume, as well as regional indicators of white matter integrity (fractional anisotropy and mean diffusivity), were analyzed.

Results: Analyses included 17 patients, without potential confounding central nervous system problems or risk factors, who had general anesthesia and surgery during infancy and 17 control subjects (age ranges, 12.3 to 15.2 yr and 12.6 to 15.1 yr, respectively). Whole brain white matter volume, as a percentage of total intracranial volume, was lower for the exposed than the nonexposed group, 37.3 ± 0.4% and 38.9 ± 0.4% (least squares mean ± SE), respectively, a difference of 1.5 percentage points (95% CI, 0.3 to 2.8; P = 0.016). Corresponding decreases were statistically significant for parietal and occipital lobes, infratentorium, and brainstem separately. White matter integrity was lower for the exposed than the nonexposed group in superior cerebellar peduncle, cerebral peduncle, external capsule, cingulum (cingulate gyrus), and fornix (cres) and/or stria terminalis. The groups did not differ in total intracranial, gray matter, and cerebrospinal fluid volumes.

Conclusions: Children who had anesthesia and surgery during infancy showed broadly distributed, decreased white matter integrity and volume. Although the findings may be related to anesthesia and surgery during infancy, other explanations are possible.