Multiple GA exposure reduces neurodevelopmental score in children, finds study

A recent analysis of the General Anesthesia compared to Spinal anesthesia (GAS) trial database has raised concerns about the potential neurodevelopmental impact of multiple anesthetic exposures in early childhood. The study published in the Anesthesiology journal found that children who underwent two or more general anesthetic (GA) exposures before the age of 5 had lower intelligence scores and greater emotional and behavioural difficulties when compared to the children with one or no GA exposures.

The multicentre study initially demonstrated that a single GA exposure for elective inguinal hernia repair in infancy had no significant impact on neurodevelopmental outcomes at ages 2 and 5. However, this secondary analysis looked to investigate whether repeated GA exposures influenced outcomes.

This research utilized data from 231 children (90 with multiple GA exposures and 141 with one or no exposures). The primary measure was the full-scale intelligence quotient (FSIQ) from the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) at age 5. Secondary outcomes included assessments of verbal and performance IQ, as well as emotional and behavioural domains, through caregiver-reported questionnaires.

The results revealed that children with multiple GA exposures scored, on average, 5.8 points lower in FSIQ than the children with one or no exposure. Also, verbal and performance IQ scores were also lower in the multiply exposed group. Emotional, behavioural, and executive function difficulties were more pronounced among these children, as reported by caregivers.

While the findings suggest a potential link between multiple GA exposures and diminished neurodevelopmental outcomes, this study acknowledged limitations. Residual confounding factors like pre-existing health conditions or the complexity of surgeries requiring multiple anesthetics, may have influenced results. Also, the small sample size limits the generalizability of the findings.

This research emphasized that while the study underlined the potential risks of multiple anesthetic exposures, the clinical significance should be interpreted cautiously. The observed reduction in intelligence scores and increased behavioural challenges highlight the importance of judicious decision-making regarding repeated surgeries requiring GA in young children. As ongoing research seeks to further explore the neurodevelopmental impact of anesthesia in early life, this study reinforces the importance of careful consideration in pediatric surgical planning and the need for strategies to reduce potential risks.

Reference:

Xin, A., Grobler, A., Bell, G., de Graaff, J. C., Dorris, L., Disma, N., McCann, M. E., Withington, D. E., & Davidson, A. J. (2024). Neurodevelopmental Outcomes After Multiple General Anaesthetic Exposure Before Five Years Of Age – A Cohort Study. In Anesthesiology. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/aln.0000000000005293