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 

Related ObG Topics:

ACOG Response to FDA Communication on Anesthesia in Pregnancy

Response to FDA’s Anesthesia Warning on Developing Brains