Newly Published
Perioperative Medicine  |   April 2018
Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota (D.O.W., S.L.B., S.J.G., R.T.W., J.S., D.H., R.P.F.)
  • Department of Psychology, Mayo Clinic, Rochester, Minnesota (M.J.Z.)
  • Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota (S.K.K., D.R.S., A.C.H., P.J.S.) Mayo Clinic, Rochester, Minnesota
  • the Department of Pediatric Medicine, Baylor College of Medicine, Houston, Texas (R.G.V.)
  • National Center for Toxicological Research, Food and Drug Administration, Jefferson, Arkansas (M.G.P., J.J.C.).
  • 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 August 15, 2017. Accepted for publication March 16, 2018.
    Submitted for publication August 15, 2017. Accepted for publication March 16, 2018.×
  • Acknowledgments: The authors thank the staff at the Psychologic Assessment Lab (Mayo Clinic, Rochester, Minnesota) for their dedicated work in subject testing, Bradley Peterson, M.D. (Children’s Hospital of Los Angeles and the Keck School of Medicine at the University of Southern California, Los Angeles, California), for his helpful comments, and Young Juhn, M.D. (Mayo Clinic), for assistance with determining socioeconomic status as measured by the HOUSES index. The authors also recognize the extraordinary contributions of Robert Colligan, Ph.D., who was crucial in the design of the study and died during its conduct; he is sorely missed.
    Acknowledgments: The authors thank the staff at the Psychologic Assessment Lab (Mayo Clinic, Rochester, Minnesota) for their dedicated work in subject testing, Bradley Peterson, M.D. (Children’s Hospital of Los Angeles and the Keck School of Medicine at the University of Southern California, Los Angeles, California), for his helpful comments, and Young Juhn, M.D. (Mayo Clinic), for assistance with determining socioeconomic status as measured by the HOUSES index. The authors also recognize the extraordinary contributions of Robert Colligan, Ph.D., who was crucial in the design of the study and died during its conduct; he is sorely missed.×
    This document has been reviewed in accordance with U.S. Food and Drug Administration policy and approved for publication. Approval does not signify that the contents necessarily reflect the position or opinions of the Food and Drug Administration, nor does mention of trade names or commercial products constitute endorsement or recommendation for use. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Food and Drug Administration.
    This document has been reviewed in accordance with U.S. Food and Drug Administration policy and approved for publication. Approval does not signify that the contents necessarily reflect the position or opinions of the Food and Drug Administration, nor does mention of trade names or commercial products constitute endorsement or recommendation for use. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Food and Drug Administration.×
  • Research Support: Supported by grant No. R01 HD071907 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, Bethesda, Maryland, and also utilized the resources of the Rochester Epidemiology Project, supported by grant No. R01 AG034676 from the National Institute on Aging of the National Institutes of Health, Bethesda, Maryland.
    Research Support: Supported by grant No. R01 HD071907 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, Bethesda, Maryland, and also utilized the resources of the Rochester Epidemiology Project, supported by grant No. R01 AG034676 from the National Institute on Aging of the National Institutes of Health, Bethesda, Maryland.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Warner: 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 / Pediatric Anesthesia
Perioperative Medicine   |   April 2018
Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study
Anesthesiology Newly Published on April 18, 2018. doi:10.1097/ALN.0000000000002232
Anesthesiology Newly Published on April 18, 2018. doi:10.1097/ALN.0000000000002232
Abstract

Background: Few studies of how exposure of children to anesthesia may affect neurodevelopment employ comprehensive neuropsychological assessments. This study tested the hypothesis that exposure to multiple, but not single, procedures requiring anesthesia before age 3 yr is associated with adverse neurodevelopmental outcomes.

Methods: Unexposed, singly exposed, and multiply exposed children born in Olmsted County, Minnesota, from 1994 to 2007 were sampled using a propensity-guided approach and underwent neuropsychological testing at ages 8 to 12 or 15 to 20 yr. The primary outcome was the Full-Scale intelligence quotient standard score of the Wechsler Abbreviated Scale of Intelligence. Secondary outcomes included individual domains from a comprehensive neuropsychological assessment and parent reports.

Results: In total, 997 children completed testing (411, 380, and 206 unexposed, singly exposed, and multiply exposed, respectively). The primary outcome of intelligence quotient did not differ significantly according to exposure status; multiply exposed and singly exposed children scoring 1.3 points (95% CI, −3.8 to 1.2; P = 0.32) and 0.5 points (95% CI, −2.8 to 1.9; P = 0.70) lower than unexposed children, respectively. For secondary outcomes, processing speed and fine motor abilities were decreased in multiply but not singly exposed children; other domains did not differ. The parents of multiply exposed children reported increased problems related to executive function, behavior, and reading.

Conclusions: Anesthesia exposure before age 3 yr was not associated with deficits in the primary outcome of general intelligence. Although secondary outcomes must be interpreted cautiously, they suggest the hypothesis that multiple, but not single, exposures are associated with a pattern of changes in specific neuropsychological domains that is associated with behavioral and learning difficulties.