Christina Schüttler1, Tino Münster, Christine Gall, Regina Trollmann, Jürgen Schüttler. 1. Chair of Medical Informatics, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany; Clinic for Anesthesia and Intensive Care Medicine, Hospital Barmherzige Brüder, Regensburg, Germany, Germany; Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany; Neuropediatrics at the Department of Pediatric and Adolescent Medicine at the University Hospital of Erlangen, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany; Anesthesiology Department, University Hospital of Erlangen, Germany.
Abstract
BACKGROUND: Experimental data have shown that the developing brain is especially vulnerable to exogenous noxious substances. The potential effects of anesthetic drugs on brain growth and development are a matter of concern. Clinical studies of children who underwent general anesthesia in their earliest years can make a major contribution to our understanding of the effects of anesthetic drugs on infants and toddlers (i.e., children under age 5). METHODS: Children born at term during the years 2007-2011 who were exposed to general anesthesia before their third birthday were included in the study. Data on general anesthesia were retrospectively evaluated, and the overall intelligence quotient (IQ) was determined prospectively as the primary target parameter. Children who had not been exposed to general anesthesia were recruited as a control group. The non-inferiority threshold was set at a difference of 5 IQ points out of a consideration of clinical relevance. RESULTS: 430 complete data sets were available from exposed children and 67 from members of the control group. The exposed group achieved a mean IQ score of 108.2, with a 95% confidence interval of [107; 109.4]; the corresponding values in the control group were 113 [110; 116.1]. Both groups achieved a mean score that was higher than the expected 100 points. After adjustment for age, socioeconomic status, and sex, the difference between the two groups was 2.9 points [0.2; 5.6], indicating a significantly better outcome in the control group than in the exposed group. The non-inferiority threshold of 5 IQ points was within the confidence interval; thus, non-inferiority was not demonstrated. CONCLUSION: The fact that both groups achieved a higher IQ score than the expected 100 points may be attributable, at least in part, to the restriction of the study to children born at term. The results indicate that general anesthesia in early childhood is not associated with markedly reduced intelligence in later years, although noninferiority could not be demonstrated.
BACKGROUND: Experimental data have shown that the developing brain is especially vulnerable to exogenous noxious substances. The potential effects of anesthetic drugs on brain growth and development are a matter of concern. Clinical studies of children who underwent general anesthesia in their earliest years can make a major contribution to our understanding of the effects of anesthetic drugs on infants and toddlers (i.e., children under age 5). METHODS: Children born at term during the years 2007-2011 who were exposed to general anesthesia before their third birthday were included in the study. Data on general anesthesia were retrospectively evaluated, and the overall intelligence quotient (IQ) was determined prospectively as the primary target parameter. Children who had not been exposed to general anesthesia were recruited as a control group. The non-inferiority threshold was set at a difference of 5 IQ points out of a consideration of clinical relevance. RESULTS: 430 complete data sets were available from exposed children and 67 from members of the control group. The exposed group achieved a mean IQ score of 108.2, with a 95% confidence interval of [107; 109.4]; the corresponding values in the control group were 113 [110; 116.1]. Both groups achieved a mean score that was higher than the expected 100 points. After adjustment for age, socioeconomic status, and sex, the difference between the two groups was 2.9 points [0.2; 5.6], indicating a significantly better outcome in the control group than in the exposed group. The non-inferiority threshold of 5 IQ points was within the confidence interval; thus, non-inferiority was not demonstrated. CONCLUSION: The fact that both groups achieved a higher IQ score than the expected 100 points may be attributable, at least in part, to the restriction of the study to children born at term. The results indicate that general anesthesia in early childhood is not associated with markedly reduced intelligence in later years, although noninferiority could not be demonstrated.
Authors: Juraj Sprung; Randall P Flick; Slavica K Katusic; Robert C Colligan; William J Barbaresi; Katarina Bojanić; Tasha L Welch; Michael D Olson; Andrew C Hanson; Darrell R Schroeder; Robert T Wilder; David O Warner Journal: Mayo Clin Proc Date: 2012-02 Impact factor: 7.616
Authors: Lena S Sun; Guohua Li; Tonya L K Miller; Cynthia Salorio; Mary W Byrne; David C Bellinger; Caleb Ing; Raymond Park; Jerilynn Radcliffe; Stephen R Hays; Charles J DiMaggio; Timothy J Cooper; Virginia Rauh; Lynne G Maxwell; Ahrim Youn; Francis X McGowan Journal: JAMA Date: 2016-06-07 Impact factor: 56.272
Authors: Adnan T Bhutta; Michael L Schmitz; Christopher Swearingen; Laura P James; Wendy L Wardbegnoche; Diana M Lindquist; Charles M Glasier; Volkan Tuzcu; Parthak Prodhan; Umesh Dyamenahalli; Michiaki Imamura; Robert D B Jaquiss; Kanwaljeet J S Anand Journal: Pediatr Crit Care Med Date: 2012-05 Impact factor: 3.624
Authors: David O Warner; Michael J Zaccariello; Slavica K Katusic; Darrell R Schroeder; Andrew C Hanson; Phillip J Schulte; Shonie L Buenvenida; Stephen J Gleich; Robert T Wilder; Juraj Sprung; Danqing Hu; Robert G Voigt; Merle G Paule; John J Chelonis; Randall P Flick Journal: Anesthesiology Date: 2018-07 Impact factor: 7.892
Authors: Mary Ellen McCann; Jurgen C de Graaff; Liam Dorris; Nicola Disma; Davinia Withington; Graham Bell; Anneke Grobler; Robyn Stargatt; Rodney W Hunt; Suzette J Sheppard; Jacki Marmor; Gaia Giribaldi; David C Bellinger; Penelope L Hartmann; Pollyanna Hardy; Geoff Frawley; Francesca Izzo; Britta S von Ungern Sternberg; Anne Lynn; Niall Wilton; Martin Mueller; David M Polaner; Anthony R Absalom; Peter Szmuk; Neil Morton; Charles Berde; Sulpicio Soriano; Andrew J Davidson Journal: Lancet Date: 2019-02-14 Impact factor: 79.321
Authors: Cor J Kalkman; Linda Peelen; Karel G Moons; Morna Veenhuizen; Marcel Bruens; Gerben Sinnema; Tom P de Jong Journal: Anesthesiology Date: 2009-04 Impact factor: 7.892
Authors: Torsten Baehner; Philipp Pruemm; Mathieu Vergnat; Boulos Asfour; Nadine Straßberger-Nerschbach; Andrea Kirfel; Michael Hamann; Andreas Mayr; Ehrenfried Schindler; Markus Velten; Maria Wittmann Journal: J Clin Med Date: 2022-09-01 Impact factor: 4.964