Cognitive and behavioral outcomes after early exposure to anesthesia and surgery

Randall Flick, Slavica K Katusic, Robert C. Colligan, Robert T. Wilder, Robert G. Voigt, Michael D. Olson, Juraj Sprung, Amy L. Weaver, Darrell R. Schroeder, David Oman Warner

Research output: Contribution to journalArticle

457 Citations (Scopus)

Abstract

BACKGROUND: Annually, millions of children are exposed to anesthetic agents that cause apoptotic neurodegeneration in immature animals. To explore the possible significance of these findings in children, we investigated the association between exposure to anesthesia and subsequent (1) learning disabilities (LDs), (2) receipt of an individualized education program for an emotional/behavior disorder (IEP-EBD), and (3) scores of group-administered achievement tests. METHODS: This was a matched cohort study in which children (N =8548) born between January 1, 1976, and December 31, 1982, in Rochester, Minnesota, were the source of cases and controls. Those exposed to anesthesia (n = 350) before the age of 2 were matched to unexposed controls (n = 700) on the basis of known risk factors for LDs. Multivariable analysis adjusted for the burden of illness, and outcomes including LDs, receipt of an IEP-EBD, and the results of groupadministered tests of cognition and achievement were outcomes. RESULTS: Exposure to multiple, but not single, anesthetic/surgery significantly increased the risk of developing LDs (hazard ratio: 2.12 [95% confidence interval: 1.26-3.54]), even when accounting for health status. A similar pattern was observed for decrements in groupadministered tests of achievement and cognition. However, exposure did not affect the rate of children receiving an individualized education program. CONCLUSIONS: Repeated exposure to anesthesia and surgery before the age of 2 was a significant independent risk factor for the later development of LDs but not the need for educational interventions related to emotion/behavior. We cannot exclude the possibility that multiple exposures to anesthesia/surgery at an early age may adversely affect human neurodevelopment with lasting consequence.

Original languageEnglish (US)
JournalPediatrics
Volume128
Issue number5
DOIs
StatePublished - Nov 2011

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Learning Disorders
Anesthesia
Education
Mental Disorders
Cognition
Anesthetics
Cost of Illness
Health Status
Emotions
Cohort Studies
Learning Disability
Surgery
Confidence Intervals
Education Program
Emotion
Risk Factors
Receipt

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

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Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. / Flick, Randall; Katusic, Slavica K; Colligan, Robert C.; Wilder, Robert T.; Voigt, Robert G.; Olson, Michael D.; Sprung, Juraj; Weaver, Amy L.; Schroeder, Darrell R.; Warner, David Oman.

In: Pediatrics, Vol. 128, No. 5, 11.2011.

Research output: Contribution to journalArticle

Flick, R, Katusic, SK, Colligan, RC, Wilder, RT, Voigt, RG, Olson, MD, Sprung, J, Weaver, AL, Schroeder, DR & Warner, DO 2011, 'Cognitive and behavioral outcomes after early exposure to anesthesia and surgery', Pediatrics, vol. 128, no. 5. https://doi.org/10.1542/peds.2011-0351
Flick, Randall ; Katusic, Slavica K ; Colligan, Robert C. ; Wilder, Robert T. ; Voigt, Robert G. ; Olson, Michael D. ; Sprung, Juraj ; Weaver, Amy L. ; Schroeder, Darrell R. ; Warner, David Oman. / Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. In: Pediatrics. 2011 ; Vol. 128, No. 5.
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abstract = "BACKGROUND: Annually, millions of children are exposed to anesthetic agents that cause apoptotic neurodegeneration in immature animals. To explore the possible significance of these findings in children, we investigated the association between exposure to anesthesia and subsequent (1) learning disabilities (LDs), (2) receipt of an individualized education program for an emotional/behavior disorder (IEP-EBD), and (3) scores of group-administered achievement tests. METHODS: This was a matched cohort study in which children (N =8548) born between January 1, 1976, and December 31, 1982, in Rochester, Minnesota, were the source of cases and controls. Those exposed to anesthesia (n = 350) before the age of 2 were matched to unexposed controls (n = 700) on the basis of known risk factors for LDs. Multivariable analysis adjusted for the burden of illness, and outcomes including LDs, receipt of an IEP-EBD, and the results of groupadministered tests of cognition and achievement were outcomes. RESULTS: Exposure to multiple, but not single, anesthetic/surgery significantly increased the risk of developing LDs (hazard ratio: 2.12 [95{\%} confidence interval: 1.26-3.54]), even when accounting for health status. A similar pattern was observed for decrements in groupadministered tests of achievement and cognition. However, exposure did not affect the rate of children receiving an individualized education program. CONCLUSIONS: Repeated exposure to anesthesia and surgery before the age of 2 was a significant independent risk factor for the later development of LDs but not the need for educational interventions related to emotion/behavior. We cannot exclude the possibility that multiple exposures to anesthesia/surgery at an early age may adversely affect human neurodevelopment with lasting consequence.",
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