Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study

David Oman Warner, Michael J Zaccariello, Slavica K Katusic, Darrell R. Schroeder, Andrew C. Hanson, Phillip Schulte, Shonie L. Buenvenida, Stephen J. Gleich, Robert T. Wilder, Juraj Sprung, Danqing Hu, Robert G. Voigt, Merle G. Paule, John J. Chelonis, Randall Flick

Research output: Contribution to journalArticle

52 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)89-105
Number of pages17
JournalAnesthesiology
Volume129
Issue number1
DOIs
StatePublished - Jul 1 2018

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General Anesthesia
Anesthesia
Safety
Intelligence
Wechsler Scales
Aptitude
Executive Function
Reading
Parents
Learning

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia : The Mayo Anesthesia Safety in Kids (MASK) Study. / Warner, David Oman; Zaccariello, Michael J; Katusic, Slavica K; Schroeder, Darrell R.; Hanson, Andrew C.; Schulte, Phillip; Buenvenida, Shonie L.; Gleich, Stephen J.; Wilder, Robert T.; Sprung, Juraj; Hu, Danqing; Voigt, Robert G.; Paule, Merle G.; Chelonis, John J.; Flick, Randall.

In: Anesthesiology, Vol. 129, No. 1, 01.07.2018, p. 89-105.

Research output: Contribution to journalArticle

Warner, David Oman ; Zaccariello, Michael J ; Katusic, Slavica K ; Schroeder, Darrell R. ; Hanson, Andrew C. ; Schulte, Phillip ; Buenvenida, Shonie L. ; Gleich, Stephen J. ; Wilder, Robert T. ; Sprung, Juraj ; Hu, Danqing ; Voigt, Robert G. ; Paule, Merle G. ; Chelonis, John J. ; Flick, Randall. / Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia : The Mayo Anesthesia Safety in Kids (MASK) Study. In: Anesthesiology. 2018 ; Vol. 129, No. 1. pp. 89-105.
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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.",
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AU - Warner, David Oman

AU - Zaccariello, Michael J

AU - Katusic, Slavica K

AU - Schroeder, Darrell R.

AU - Hanson, Andrew C.

AU - Schulte, Phillip

AU - Buenvenida, Shonie L.

AU - Gleich, Stephen J.

AU - Wilder, Robert T.

AU - Sprung, Juraj

AU - Hu, Danqing

AU - Voigt, Robert G.

AU - Paule, Merle G.

AU - Chelonis, John J.

AU - Flick, Randall

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N2 - 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.

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