Head Injury and Neuroanesthesia
Anesthetic Neurotoxicity: A Difficult Dragon to Slay
Thomas J, Crosby G, Drummond JC, et al (Univ of Iowa Carver College of Medicine; Brigham and Women’s Hosp, Boston, MA; Univ of California, San Diego) Anesth Analg 113:969-971, 2011§
Anesthetic neurotoxicity is a topic that is being widely discussed without much solid evidence other than indications noted in animal studies. It is difficult to design prospective, randomized controlled trials (RCTs) that can determine if anesthetic neurotoxicity occurs in children and what adverse effects it produces. Researchers currently lack sufficient knowledge about possible confounding issues. An administrative database of siblings was used to determine if anesthesia and surgery in the child’s first 3 years of life produce subsequent behavioral or developmental disorders.
From a Medicaid database, 5824 sibling pairs were identified. Three hundred four had surgery before age 3 years, and their outcomes were compared with those of 10,146 children who did not have surgery.
Of the 304 children having surgery, 24.7% had a diagnosis of a developmental or behavioral disorder, whereas 8.8% of the comparison group had these diagnoses. After adjusting for other perinatal disorders that could have altered outcome, the hazard ratio for having a developmental or behavioral diagnosis and anesthesia and surgery was 1.7. However, the difference between groups disappeared when the analysis considered only children who had a single procedure. When the analysis was limited to 138 matched twin pairs, the children having surgery had no greater risk of a diagnosis of developmental or behavioral problems than those not having surgery.