Julia Grabowski1, Adam Goldin2, L Grier Arthur3, Alana L Beres4, Yigit S Guner5, Yue-Yung Hu6, Akemi L Kawaguchi7, Lorraine I Kelley-Quon8, Jarod P McAteer9, Doug Miniati10, Elizabeth J Renaud11, Robert Ricca12, Mark B Slidell13, Caitlin A Smith2, Juan E Sola14, Stig Sømme15, Cynthia D Downard16, Ankush Gosain17, Patricia Valusek18, Shawn D St Peter19, Narasimhan 'Sim' Jagannathan20, Roshni Dasgupta21. 1. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, 225 E. Chicago, Box 63, Chicago, IL 60611, United States. Electronic address: Jgrabowski312@gmail.com. 2. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, United States. 3. Division of Minimally Invasive, Thoracic and General Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, United States. 4. Division of Pediatric General, Thoracic and Fetal Surgery, University of California, Davis. Sacramento, CA, United States. 5. Department of Surgery, Children's Hospital of Orange County Division of Pediatric Surgery, University of California, Irvine, United States. 6. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, 225 E. Chicago, Box 63, Chicago, IL 60611, United States. 7. Department of Pediatric Surgery, Mc Govern Medical School at the University of Texas HSC, Houston, TX, United States. 8. Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Department of Preventive Medicine, University of Southern California Los Angeles, CA, United States. 9. Alaska Pediatric Surgery, Anchorage, AK, United States. 10. Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA, United States. 11. Division of Pediatric Surgery, Hasbro Children's Hospital, Alpert Medical School at Brown University, Providence, RI, United States. 12. Division of Pediatric Surgery, Naval Medical Center Portsmouth, VA, United States. 13. Section of Pediatric Surgery, Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States. 14. Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, United States. 15. Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States. 16. Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY, United States. 17. Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, United States. 18. Pediatric Surgical Associates, Ltd., Children's Minnesota, United States. 19. Children's Mercy Hospital, Kansas City, MI, United States. 20. Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL, United States. 21. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States.
Abstract
BACKGROUND: There is growing concern regarding the impact of general anesthesia on neurodevelopment in children. Pre-clinical animal studies have linked anesthetic exposure to abnormal central nervous system development, but it is unclear whether these results translate into humans. The purpose of this systematic review from the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice (OEBP) Committee was to review, summarize, and evaluate the evidence regarding the neurodevelopmental impact of general anesthesia on children and identify factors that may affect the risk of neurotoxicity. METHODS: Medline, Cochrane, Embase, Web of Science, and Scopus databases were queried for articles published up to and including December 2017 using the search terms "general anesthesia and neurodevelopment" as well as specific anesthetic agents. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to screen manuscripts for inclusion in the review. A consensus statement of recommendations in response to each study question was synthesized based upon the best available evidence. RESULTS: In total, 493 titles were initially identified, with 56 articles selected for full analysis and 44 included for review. Based on currently available developmental assessment tools, a single exposure to general anesthesia does not appear to have a significant effect on general neurodevelopment, although prolonged or multiple anesthetic exposures may have some adverse effects. Exposure to general anesthesia may affect different domains of development at different ages. Regional anesthetic techniques with the addition of dexmedetomidine and/or some intravenous agents may mitigate the risks of neurotoxicity. This approach may be performed safely in some patients and can be considered as an option in selected short procedures. CONCLUSION: There is no conclusive evidence that a single short anesthetic in infancy has a detectable neurodevelopmental effect. Data do not support waiting until later in childhood to perform general anesthesia for single short procedures. With the complexities and nuances of different anesthetic methods, patients and procedures, the planning and execution of anesthesia for the pediatric patient is generally best accomplished by an anesthesiologist, ideally a pediatric anesthesiologist. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly level 3-4).
BACKGROUND: There is growing concern regarding the impact of general anesthesia on neurodevelopment in children. Pre-clinical animal studies have linked anesthetic exposure to abnormal central nervous system development, but it is unclear whether these results translate into humans. The purpose of this systematic review from the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice (OEBP) Committee was to review, summarize, and evaluate the evidence regarding the neurodevelopmental impact of general anesthesia on children and identify factors that may affect the risk of neurotoxicity. METHODS: Medline, Cochrane, Embase, Web of Science, and Scopus databases were queried for articles published up to and including December 2017 using the search terms "general anesthesia and neurodevelopment" as well as specific anesthetic agents. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to screen manuscripts for inclusion in the review. A consensus statement of recommendations in response to each study question was synthesized based upon the best available evidence. RESULTS: In total, 493 titles were initially identified, with 56 articles selected for full analysis and 44 included for review. Based on currently available developmental assessment tools, a single exposure to general anesthesia does not appear to have a significant effect on general neurodevelopment, although prolonged or multiple anesthetic exposures may have some adverse effects. Exposure to general anesthesia may affect different domains of development at different ages. Regional anesthetic techniques with the addition of dexmedetomidine and/or some intravenous agents may mitigate the risks of neurotoxicity. This approach may be performed safely in some patients and can be considered as an option in selected short procedures. CONCLUSION: There is no conclusive evidence that a single short anesthetic in infancy has a detectable neurodevelopmental effect. Data do not support waiting until later in childhood to perform general anesthesia for single short procedures. With the complexities and nuances of different anesthetic methods, patients and procedures, the planning and execution of anesthesia for the pediatric patient is generally best accomplished by an anesthesiologist, ideally a pediatric anesthesiologist. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly level 3-4).
Authors: Megan Barcroft; Christopher McKee; Darren P Berman; Rachel A Taylor; Brian K Rivera; Charles V Smith; Jonathan L Slaughter; Afif El-Khuffash; Carl H Backes Journal: Clin Perinatol Date: 2022-01-21 Impact factor: 3.430
Authors: Patricia L Purcell; Nicholas L Deep; Susan B Waltzman; J Thomas Roland; Sharon L Cushing; Blake C Papsin; Karen A Gordon Journal: Trends Hear Date: 2021 Jan-Dec Impact factor: 3.293