Abstract
BackgroundGeneral anesthesia has been linked to impaired brain development in immature animals and young children. In this study the influence of orthopedic surgery under general anesthesia on the intelligence of school age children has been evaluated.MethodsA total of 209 subjects aged 6–12 years were recruited and allocated into 4 groups according to the duration of general anesthesia, including a control group (n = 30), short (< 1 h, n = 49), moderate- (1–3 h, n = 51) and long-duration groups (> 3 h, n = 79), respectively. The intelligence quotient (IQ) of the subjects was measured by the Raven’s Standard Progressive Matrices (RSPM) before and after orthopedic surgery under general anesthesia of various durations (vide supra).ResultsThe IQ score decreased significantly in the long-duration group at 1 month post-operation compared with the pre-operation score (P < 0.001), and IQ did not recover completely at 3 months postoperatively (P < 0.05), but had recovered when measured at the 1-year follow-up. Moreover, this study showed that the development of children’s intelligence was affected by the exposure time to anesthetics at a younger age (OR = 5.26, 95% CI:2.70–8.41, P < 0.001), having a mother with a low education level (OR = 2.71, 95% CI:1.24–6.14, P = 0.014) and premature birth (OR = 2.76, 95% CI:1.34–5.46, P = 0.005).ConclusionsMore than 3 h general anesthesia influenced the IQ of school age children for up to 3 months after orthopedic surgery. Beside extended exposure time to anesthetics additional factors for post-operative IQ reduction were younger children age, mothers with low educational levels and premature birth.Trial registrationChinese Clinical Trial Registry with registration number ChiCTR-OOC-17013497 retrospectively registered on 11/23/2017.
Highlights
General anesthesia has been linked to impaired brain development in immature animals and young children
A recent study has provided new evidence for a possible association between general anesthesia in young children with long-term diminution of language abilities and cognition, as well as regional volumetric alterations in brain structure [13]. It remains unresolved whether anesthesia itself is the cause, or that other unidentified factors associated with anesthesia are causally attributable to cognitive and behavioral problems in children, the potential side effects of general anesthesia for children is a major concern
Among 300 patients enrolled in the anesthesia exposure groups, a total of 64 children were excluded from the study due to physiological and/or psychological abnormalities during or after surgery (n = 32) or for failure to complete the required 4 Raven’s Standard Progressive Matrices (RSPM) tests (n = 6, 9 and 17 for the short-duration, moderate-duration and longduration groups, respectively.)
Summary
General anesthesia has been linked to impaired brain development in immature animals and young children. Accumulating retrospective epidemiological studies have suggested a possible link between general anesthesia and cognitive function in children and it is generally believed that the effect of anesthetics on the developing. A recent study has provided new evidence for a possible association between general anesthesia in young children with long-term diminution of language abilities and cognition, as well as regional volumetric alterations in brain structure [13]. It remains unresolved whether anesthesia itself is the cause, or that other unidentified factors associated with anesthesia are causally attributable to cognitive and behavioral problems in children, the potential side effects of general anesthesia for children is a major concern
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