By: 22 June 2016
Single exposure to general anaesthesia before age three does not cause cognitive deficits

Single exposure to general anaesthesia before age three does not cause cognitive deficits

A single exposure to general anaesthesia poses no cognitive risk to healthy children under age three, a critical time in brain development, according to a multicenter study led by researchers at Columbia University Medical Center and NewYork-Presbyterian/Morgan Stanley Children’s Hospital. Findings from the PANDA (Pediatric Anesthesia Neurodevelopment Assessment) study, the largest and most comprehensive of its kind, were published in the Journal of the American Medical Association.

“A number of animal studies have suggested that exposure to commonly used anaesthetic agents in early development could lead to deficits in learning, memory, attention, and other cognitive functions,” says lead author Lena S. Sun, MD, the Emanuel M. Papper Professor of Peadiatric Anesthesiology and professor of peadiatrics at Columbia and chief of pediatric anesthesiology at NewYork-Presbyterian/Morgan Stanley Children’s Hospital. “However, few clinical studies have adequately addressed whether this is also true in humans. Based on our findings, we can reassure parents that one exposure to anaesthesia is safe for healthy young children.”

“The potential neurotoxicity of anaesthetic agents commonly used in general anaesthesia has been one of the most pressing concerns in peadiatric surgery in the past decade. The PANDA project is among the most rigorously designed studies aimed at addressing this concern. Our findings should be reassuring to millions of parents whose young children need to undergo surgical procedures under general anaesthesia across the world each year,” said Guohua Li, Mieczyslaw Finster Professor of Anesthesiology at the College of Physicians and Surgeons, professor of epidemiology at the Mailman School of Public Health, and a co-author of the paper.

The PANDA study examined whether exposure to a single anaesthetic of short duration (median of 80 minutes) in children under age three had an effect on global cognitive function (IQ) later in life.

The study included 105 healthy children who underwent surgical repair of inguinal hernia—one of the most common operations of early childhood—at one of four sites.

IQ scores and secondary neurodevelopmental outcomes, including memory, learning, processing speed, visuospatial function, attention, executive function, language, and behavior, were assessed when the children were between the ages of 8 and 15, allowing enough time after exposure to anaesthesia for any impairments to emerge. Outcomes for each child were compared with those of a healthy, biologically related sibling of a similar age who was not exposed to anesthesia.

“There was no significant difference in IQ scores between the children who were exposed to anesthesia and siblings who were not,” says Dr. Sun. “We also saw no difference in most of the secondary outcomes, although more children in the group exposed to anaesthesia exhibited internalising behaviour that required further clinical evaluation. That’s an area that needs to be further explored.”

Internalising behaviours are behaviours that are directed inward. Examples of negative or problematic internalising behaviours include anxiety, social withdrawal, and feelings of loneliness and guilt.

“Overall, this is good news for parents whose children need anaesthesia for elective surgery or a diagnostic procedure,” said Dr. Sun.

“But the PANDA study leaves some important questions unanswered,” she adds. “We need to take a closer look at the effect of anaesthesia on cognitive function in girls, since most of the subjects in the group exposed to anaesthesia were boys. Also, we need to look at the effects of repeated and prolonged exposure to anaesthesia, as well as the effects of anaesthesia on more vulnerable subgroups, such as children with serious medical conditions.”

Reference: Francis X. McGowan, MD et al. Association Between A Single General Anesthetic Exposure Before Age 36 Months and Neurocognitive Outcomes in Later ChildhoodJAMA, June 2016 DOI:1001/jama.2016.6967

Source: Columbia University Medical Center