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Grand Rounds

Does General Anesthesia Exposure in Infancy Impact Neurodevelopment?

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BACKGROUND AND PURPOSE:

  • Professional guidance has raised concern over exposure of infants to general anesthesia and impact on neurodevelopment
  • McCann et al. (Lancet, 2019) sought to determine whether general anesthesia in early infancy affects neurodevelopmental outcomes

METHODS:

  • International, assessor-masked, equivalence, randomized, controlled trial (RCT)
  • Participants
    • <60 weeks’ postmenstrual age
    • Born >26 weeks
    • Undergoing inguinal herniorrhaphy
    • No previous exposure to general anesthesia
    • No risk factors for neurological injury
  • Patients received either
    • Awake-regional anesthetic (control)
    • Sevoflurane-based general anesthetic
  • Primary outcome measure at 5 years of age
    • Full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III)
  • Secondary outcomes included
    • Additional measures for executive function | Behavioral checklist

RESULTS:

  • 205 children in the awake-regional anesthesia group | 242 in the general anesthesia group
  • The median duration of general anesthesia: 54 min
  • The mean FSIQ score was not statistically different between groups
    • Awake-regional anesthesia group: 99.08
    • general anesthesia group: 98.97
  • The results of the intention-to-treat analysis were similar to those of the per-protocol analysis

CONCLUSION:

  • Previous cohort studies may have been biased by confounding
    • For example, condition requiring surgery may be associated with adverse neurodevelopmental outcome
    • Current study only RCT to assess effects on neurodevelopment
  • There was not statistical differences and strong evidence for equivalence in neurodevelopment at 5 years between those children exposed to approximately 1 hour of regional anesthesia and those children receiving awake regional block
  • Current FDA warning regarding risks of general anesthesia could have potential harms, including parents and surgeons delaying procedures
  • The authors state that this study

…being consistent with data from several previous cohort studies, provides strong evidence that just under 1 h of general anaesthesia in infancy does not cause significant neurocognitive or behavioural deficits

Learn More – Primary Sources: 

Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial 

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Related ObG Topics:

ACOG Response to FDA Communication on Anesthesia in Pregnancy
Response to FDA’s Anesthesia Warning on Developing Brains

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