Do general anesthetics affect children's neurocognitive development?
DOI:
https://doi.org/10.15574/PS.2025.3(88).117122Keywords:
neonates, pain, general anesthetics neurotoxicity, neurodevelopment, general anesthesia, neurocognitive and behavioral outcomes, long-term cognitive deficitsAbstract
General anesthesia is a necessary component not only for surgical interventions, but also for diagnostic tests, as well as painful procedures. At the same time, there are many reports about the negative effects of general anesthetics on neurocognitive development in children.
The aim is to summarize and highlight current global evidence on the general anesthetic neurotoxicity in newborns and young children. The most vulnerable period is the age of two to four years, when active neurogenesis and synaptogenesis occur. Exposure of general anesthetics in this period can be especially dangerous. In this regard, the FDA issued a message about the possibility of a negative impact of general anesthesia in young children and pregnant women in the third trimester of pregnancy. At the same time, this category of patients may face life-threatening conditions, when surgery and anesthesia are necessary. Therefore, health care professionals need to balance the benefits and risks when planning operations in young children and pregnant women, especially in children under three years of age and the expected duration of the operation is more than three hours. Current global evidence shows a negative effect of general anesthesia in neonatal period on behavior and learning in late childhood. However, anesthesia exposure was not associated with deficits of general intelligence. Such data were found in neonates and young children.
Conclusions. Probably, the anesthesia outcomes are influenced not only by general anesthetics, but also by careful planning, provision of anesthesia by qualified experienced medical stuff, high level of clinical organization to ensure safety and correct patient management.
The authors declare no conflict of interest.
References
Brewer CL, Baccei ML. (2020). The development of pain circuits and unique effects of neonatal injury. Journal of neural transmission (Vienna, Austria : 1996). 127(4): 467-479. https://doi.org/10.1007/s00702-019-02059-z; PMid:31399790 PMCid:PMC7007840
Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G et al. (2016). Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet (London, England). 387(10015): 239-250. https://doi.org/10.1016/S0140-6736(15)00608-X; PMid:26507180
FDA. (2017, Apr 21). Drug Safety Communication. URL: https://www.fda.gov/Drugs/DrugSafety/ucm532356.htm.
Hall R, Anand KJS. (2005) Short- and Long-term Impact of Neonatal Pain and Stress: More Than an Ouchie. Neoreviews. 6(2): 69-75. https://doi.org/10.1542/neo.6-2-e69
Hall R, Anand KJS. (2005). Physiology of pain and stress in the newborn. Neoreviews. 6(2): 61-68. https://doi.org/10.1542/neo.6-2-e61
Hansen TG. (2017). Use of anesthetics in young children Consensus statement of the European Society of Anaesthesiology (ESA), the European Society for Paediatric Anaesthesiology (ESPA), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Safe Tots Anaesthesia Research Initiative (EuroSTAR). Paediatric anaesthesia. 27(6): 558-559. https://doi.org/10.1111/pan.13160; PMid:28474809
Ing C, Jackson WM, Zaccariello MJ, Goldberg TE, McCann ME, Grobler A et al. (2021). Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis. British journal of anaesthesia. 126(2): 433-444. https://doi.org/10.1016/j.bja.2020.10.022; PMid:33250180 PMCid:PMC8040118
Lerman J. (2023) Neonatal anesthesia. 2nd edition. Springer Nature: 653. https://doi.org/10.1007/978-3-031-25358-4
McCann ME, de Graaff JC, Dorris L, Disma N, Withington D, Bell G et al. (2019). Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet (London, England). 393(10172): 664-677. https://doi.org/10.1016/S0140-6736(18)32485-1; PMid:30782342
McMahon SB, Koltzenburg M, Tracey I, Turk DC. (2013). Wall and Melzack's textbook of pain. 6th Edition. Philadelphia, PA: Elsevier Saunders: 1504.
Reighard C, Junaid S, Jackson WM, Arif A, Waddington H et al. (2022). Anesthetic Exposure During Childhood and Neurodevelopmental Outcomes: A Systematic Review and Meta-analysis. JAMA network open. 5(6): e2217427. https://doi.org/10.1001/jamanetworkopen.2022.17427; PMid:35708687 PMCid:PMC9204549
Sun LS, Li G, Miller TL, Salorio C, Byrne MW, Bellinger DC et al. (2016). Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. JAMA. 315(21): 2312-2320. https://doi.org/10.1001/jama.2016.6967; PMid:27272582 PMCid:PMC5316422
Wainwright CE, Vidmar S, Anderson V, Bourgeat P, Byrnes C, Carlin JB et al. (2024). Long-term outcomes of early exposure to repeated general anaesthesia in children with cystic fibrosis (CF-GAIN): a multicentre, open-label, randomised controlled phase 4 trial. The Lancet. Respiratory medicine. 12(9): 703-713. https://doi.org/10.1016/S2213-2600(24)00170-X; PMid:38851197
Warner DO, Zaccariello MJ, Katusic SK, Schroeder DR, Hanson AC, Schulte PJ et al. (2018). Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study. Anesthesiology. 129(1): 89-105. https://doi.org/10.1097/ALN.0000000000002232; PMid:29672337 PMCid:PMC6008202
Zhou H, Sun W, Ning L, Kang J, Jin Y, Dong C. (2024). Early exposure to general anesthesia may contribute to later attention-deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis of cohort studies. Journal of clinical anesthesia. 98: 111585. https://doi.org/10.1016/j.jclinane.2024.111585; PMid:39153353
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