Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2017

Open Access 01-12-2017 | Research article

Long-duration general anesthesia influences the intelligence of school age children

Authors: Qingqing Zhang, Yuanzhi Peng, Yingwei Wang

Published in: BMC Anesthesiology | Issue 1/2017

Login to get access

Abstract

Background

General anesthesia has been linked to impaired brain development in immature animals and young children. In this study the influence of orthopedic surgery under general anesthesia on the intelligence of school age children has been evaluated.

Methods

A total of 209 subjects aged 6–12 years were recruited and allocated into 4 groups according to the duration of general anesthesia, including a control group (n = 30), short (< 1 h, n = 49), moderate- (1–3 h, n = 51) and long-duration groups (> 3 h, n = 79), respectively. The intelligence quotient (IQ) of the subjects was measured by the Raven’s Standard Progressive Matrices (RSPM) before and after orthopedic surgery under general anesthesia of various durations (vide supra).

Results

The IQ score decreased significantly in the long-duration group at 1 month post-operation compared with the pre-operation score (P < 0.001), and IQ did not recover completely at 3 months postoperatively (P < 0.05), but had recovered when measured at the 1-year follow-up. Moreover, this study showed that the development of children’s intelligence was affected by the exposure time to anesthetics at a younger age (OR = 5.26, 95% CI:2.70–8.41, P < 0.001), having a mother with a low education level (OR = 2.71, 95% CI:1.24–6.14, P = 0.014) and premature birth (OR = 2.76, 95% CI:1.34–5.46, P = 0.005).

Conclusions

More than 3 h general anesthesia influenced the IQ of school age children for up to 3 months after orthopedic surgery. Beside extended exposure time to anesthetics additional factors for post-operative IQ reduction were younger children age, mothers with low educational levels and premature birth.

Trial registration

Chinese Clinical Trial Registry with registration number ChiCTR-OOC-17013497 retrospectively registered on 11/23/2017.
Literature
1.
Brambrink AM, Evers AS, Avidan MS, Farber NB, Smith DJ, Zhang X, et al. Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain. Anesthesiology. 2010;112(4):834–41.CrossRefPubMedPubMedCentral
2.
Palanisamy A, Baxter MG, Keel PK, Xie Z, Crosby G, Culley DJ. Rats exposed to isoflurane in utero during early gestation are behaviorally abnormal as adults. Anesthesiology. 2011;114(3):521–8.CrossRefPubMedPubMedCentral
3.
Paule MG, Li M, Allen RR, Liu F, Zou X, Hotchkiss C, et al. Ketamine anesthesia during the first week of life can cause long-lasting cognitive deficits in rhesus monkeys. Neurotoxicol Teratol. 2011;33(2):220–30.CrossRefPubMedPubMedCentral
4.
Sanchez V, Feinstein SD, Lunardi N, Joksovic PM, Boscolo A, Todorovic SM, et al. General anesthesia causes long-term impairment of mitochondrial morphogenesis and synaptic transmission in developing rat brain. Anesthesiology. 2011;115(5):992–1002.CrossRefPubMedPubMedCentral
5.
Tan H, Ren RR, Xiong ZQ, Wang YW. Effects of ketamine and midazolam on morphology of dendritic spines in hippocampal CA1 region of neonatal mice. Chin Med J. 2009;122(4):455–9.PubMed
6.
Zhu C, Gao J, Karlsson N, Li Q, Zhang Y, Huang Z, et al. Isoflurane anesthesia induced persistent, progressive memory impairment, caused a loss of neural stem cells, and reduced neurogenesis in young, but not adult, rodents. J Cereb Blood Flow Metab. 2010;30(5):1017–30.CrossRefPubMedPubMedCentral
7.
Flick RP, Katusic SK, Colligan RC, Wilder RT, Voigt RG, Olson MD, et al. Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics. 2011;128(5):e1053–61.CrossRefPubMedPubMedCentral
8.
Ing C, DiMaggio C, Whitehouse A, Hegarty MK, Brady J, Ungern-Sternberg v. BS, et al. long-term differences in language and cognitive function after childhood exposure to anesthesia. Pediatrics. 2012;130(3):e476–85.CrossRefPubMed
9.
Vutskits L, Davis PJ, Hansen TG. Anesthetics and the developing brain: time for a change in practice? A pro/con debate. Paediatr Anaesth. 2012;22(10):973–80.CrossRefPubMed
10.
Wilder RT, Flick RP, Sprung J, Katusic SK, Barbaresi WJ, Mickelson C, et al. Early exposure to anesthesia and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;110(4):796–804.CrossRefPubMedPubMedCentral
11.
Bartels M, Althoff RR, Boomsma DI. Anesthesia and cognitive performance in children: no evidence for a causal relationship. Twin Res Hum Genet. 2009;12(3):246–53.CrossRefPubMed
12.
DiMaggio C, Sun LS, Li G. Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort. Anesth Analg. 2011;113(5):1143–51.CrossRefPubMedPubMedCentral
13.
Backeljauw B, Holland SK, Altaye M, Loepke AW. Cognition and brain structure following early childhood surgery with anesthesia. Pediatrics. 2015;136(1):e1–12.CrossRefPubMedPubMedCentral
14.
Tutar HE, Ocal B, Imamoglu A, Atalay S. Dispersion of QT and QTc interval in healthy children, and effects of sinus arrhythmia on QT dispersion. Heart. 1998;80(1):77–9.CrossRefPubMedPubMedCentral
15.
O'Leary UM, Rusch KM, Guastello SJ. Estimating age-stratified WAIS-R IQS from scores on the Raven's standard progressive matrices. J Clin Psychol. 1991;47(2):277–84.CrossRefPubMed
16.
Mellon RD, Simone AF, Rappaport BA. Use of anesthetic agents in neonates and young children. Anesth Analg. 2007;104(3):509–20.CrossRefPubMed
17.
Vieira ME, Linhares MB. Developmental outcomes and quality of life in children born preterm at preschool- and school-age. J Pediatr. 2011;87(4):281–91.CrossRef
18.
Kirkegaard I, Obel C, Hedegaard M, Henriksen TB. Gestational age and birth weight in relation to school performance of 10-year-old children: a follow-up study of children born after 32 completed weeks. Pediatrics. 2006;118(4):1600–6.CrossRefPubMed
19.
Mathiasen R, Hansen BM, Andersen AM, Forman JL, Greisen G. Gestational age and basic school achievements: a national follow-up study in Denmark. Pediatrics. 2010;126(6):e1553–61.CrossRefPubMed
20.
Moreira RS, Magalhaes LC, Alves CR. Effect of preterm birth on motor development, behavior, and school performance of school-age children: a systematic review. J Pediatr. 2014;90(2):119–34.CrossRef
21.
Charkaluk ML, Truffert P, Marchand-Martin L, Mur S, Kaminski M, Ancel PY, et al. Very preterm children free of disability or delay at age 2: predictors of schooling at age 8: a population-based longitudinal study. Early Hum Dev. 2011;87(4):297–302.CrossRefPubMed
22.
Havidich JE, Beach M, Dierdorf SF, Onega T, Suresh G, Cravero JP. Preterm versus term children: analysis of sedation/anesthesia adverse events and longitudinal risk. Pediatrics. 2016;137(3):e20150463.CrossRefPubMed
23.
Chiu PH, Ramar K, Chen KC, Tsai YJ, Lin CM, Chiang YC, et al. Can pillar suturing promote efficacy of adenotonsillectomy for pediatric OSAS? A prospective randomized controlled trial. Laryngoscope. 2013;123(10):2573–7.PubMed
24.
Wei Y, Zhao Y, Zhang S, Zhang Y, Cheng H. Analysis on therapeutic efficacy of different approaches for treating fungal maxillary sinusitis. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013;27(2):65–7.PubMed
25.
26.
Oron Y, Zwecker-Lazar I, Levy D, Kreitler S, Roth Y. Cerumen removal: comparison of cerumenolytic agents and effect on cognition among the elderly. Arch Gerontol Geriatr. 2011;52(2):228–32.CrossRefPubMed
Metadata
Title
Long-duration general anesthesia influences the intelligence of school age children
Authors
Qingqing Zhang
Yuanzhi Peng
Yingwei Wang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2017
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-017-0462-8

Other articles of this Issue 1/2017

BMC Anesthesiology 1/2017 Go to the issue

Research article

Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airways in mannequins by novices

Research article

Assessing anesthesiology residents’ out-of-the-operating-room (OOOR) emergent airway management

Research article

Effect of ultrasonography and fluoroscopic guidance on the incidence of complications of cannulation in extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a retrospective observational study

Research article

The role of increased body mass index in outcomes of sepsis: a systematic review and meta-analysis

Research article

Assessing advances in regional anesthesia by their portrayals in meta-analyses: an alternative view on recent progress

Research article

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial