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Open Access 01-12-2021 | Local Anesthesia in Dentistry | Research article

The effect of sevoflurane anesthesia for dental procedure on neurocognition in children: a prospective, equivalence, controlled trial

Authors: Pinping Zhou, Chao Zhang, Guijin Huang, Yuan Hu, Wenzhu Ma, Cong Yu

Published in: BMC Pediatrics | Issue 1/2021

Abstract

Background

Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children’s life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to whether DGA in children has an adverse effect on neurocognition.

Methods

In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition was used to evaluate the neurocognitive function of children at 6 months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. The predefined clinical equivalence margin was 5 (1/3 SD of FSIQ score). If the 95% CI of the difference between the average FSIQ score of the two groups is within − 5 to + 5, then the two groups are equivalent.

Results

The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110–160). The mean FSIQ score in the general anesthesia group was 103·12 (SD 8.94), and the mean of the local anesthesia group was 103·58 (SD 8.40). There was equivalence in means of FSIQ score between the two groups (local minus general anesthesia 0.46, 95% CI − 2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Only the mother’s education could affect the primary outcome.

Conclusions

In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurocognitive function at 6 months after surgery compared with awake-local anesthesia.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018.

Du MQ, Li Z, Jiang H, Wang X, Feng XP, Hu Y, et al. Dental caries status and its associated factors among 3- to 5-year-old children in China: a National Survey. Chin J Dent Res. 2018;21(3):167–79. https://doi.org/10.3290/j.cjdr.a41076.

Blumer S, Costa L, Peretz B. Success of dental treatments under behavior management, sedation and general anesthesia. J Clin Pediatr Dent. 2017;41(4):308–11. https://doi.org/10.17796/1053-4628-41.4.308.CrossRefPubMed

Blumer S, Costa L, Peretz B. Success of dental treatments under behavior management, sedation and general anesthesia. J Clin Pediatr Dent. 2019;43(6):413–6. https://doi.org/10.17796/1053-4625-43.6.9.CrossRefPubMed

Chao Z, Gui Jin H, Cong Y. The effect of general anesthesia for ambulatory dental treatment on children in Chongqing, Southwest China. Paediatr Anaesth. 2017;27(1):98–105. https://doi.org/10.1111/pan.12983.CrossRefPubMed

Briner A, Nikonenko I, De Roo M, Dayer A, Muller D, Vutskits L. Developmental stage-dependent persistent impact of propofol anesthesia on dendritic spines in the rat medial prefrontal cortex. Anesthesiology. 2011;115(2):282–93. https://doi.org/10.1097/ALN.0b013e318221fbbd.CrossRefPubMed

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. https://doi.org/10.1016/j.ntt.2011.01.001.

Schaefer ML, Wang M, Perez PJ, Coca Peralta W, Xu J, Johns RA. Nitric oxide donor prevents neonatal isoflurane-induced impairments in synaptic plasticity and memory. Anesthesiology. 2019;130(2):247–62. https://doi.org/10.1097/ALN.0000000000002529.CrossRefPubMedPubMedCentral

Davidson AJ, Sun LS. Clinical evidence for any effect of anesthesia on the developing brain. Anesthesiology. 2018;128(4):840–53. https://doi.org/10.1097/ALN.0000000000001972.CrossRef

Andropoulos DB. Effect of anesthesia on the developing brain: infant and fetus. Fetal Diagn Ther. 2018;43(1):1–11. https://doi.org/10.1159/000475928.CrossRefPubMed

10.

Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet. 2016;387(10015):239–50. https://doi.org/10.1016/S0140-6736(15)00608-X.

11.

McCann ME, de Graaff JC, Dorris L, Disma N, Withington D, Bell G, et al. 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. 2019;393(10172):664–77. https://doi.org/10.1016/S0140-6736(18)32485-1.

12.

Glatz P, Sandin RH, Pedersen NL, Bonamy AK, Eriksson LI, Granath F. Association of anesthesia and surgery during childhood with long-term academic performance. JAMA Pediatr. 2017;171(1):e163470. https://doi.org/10.1001/jamapediatrics.2016.3470.CrossRefPubMed

13.

Sun LS, Li G, Miller TL, Salorio C, Byrne MW, Bellinger DC, et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA. 2016;315(21):2312–20. https://doi.org/10.1001/jama.2016.6967.

14.

Zhang Q, Peng Y, Wang Y. Long-duration general anesthesia influences the intelligence of school age children. BMC Anesthesiol. 2017;17(1):170. https://doi.org/10.1186/s12871-017-0462-8.CrossRefPubMedPubMedCentral

15.

Oba S, Türk H. A case report of multiple anesthesia for pediatric surgery: 80 anesthesia applications in a period of 6 years. BMC Anesthesiol. 2018;18(1):175. https://doi.org/10.1186/s12871-018-0639-9.CrossRefPubMedPubMedCentral

16.

Gunter JB. Benefit and risks of local anesthetics in infants and children. Paediatr Drugs. 2002;4(10):649–72. https://doi.org/10.2165/00128072-200204100-00003.CrossRefPubMed

17.

Clausen NG, Kahler S, Hansen TG. Systematic review of the neurocognitive outcomes used in studies of paediatric anaesthesia neurotoxicity. Br J Anaesth. 2018;120(6):1255–73. https://doi.org/10.1016/j.bja.2017.11.107.CrossRef

18.

McNulty H, Rollins M, Cassidy T, Caffrey A, Marshall B, Dornan J, et al. Effect of continued folic acid supplementation beyond the first trimester of pregnancy on cognitive performance in the child: a follow-up study from a randomized controlled trial (FASSTT offspring trial). BMC Med. 2019;17(1):196. https://doi.org/10.1186/s12916-019-1432-4.

19.

Schneuer FJ, Bentley JP, Davidson AJ, Holland AJ, Badawi N, Martin AJ, et al. The impact of general anesthesia on child development and school performance: a population-based study. Paediatr Anaesth. 2018;28(6):528–36. https://doi.org/10.1111/pan.13390.

20.

Hu D, Flick RP, Zaccariello MJ, Colligan RC, Katusic SK, Schroeder DR, et al. Association between exposure of young children to procedures requiring general anesthesia and learning and behavioral outcomes in a population-based birth cohort. Anesthesiology. 2017;127(2):227–40. https://doi.org/10.1097/ALN.0000000000001735.

21.

Lin EP, Lee JR, Lee CS, Deng M, Loepke AW. Do anesthetics harm the developing human brain? An integrative analysis of animal and human studies. Neurotoxicol Teratol. 2017;60:117–28. https://doi.org/10.1016/j.ntt.2016.10.008.CrossRefPubMed

22.

Warner DO, Zaccariello MJ, Katusic SK, Schroeder DR, Hanson AC, Schulte PJ, et al. Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the Mayo anesthesia safety in kids (MASK) study. Anesthesiology. 2018;129(1):89–105. https://doi.org/10.1097/ALN.0000000000002232.

23.

Vutskits L, Davidson A. Update on developmental anesthesia neurotoxicity. Curr Opin Anaesthesiol. 2017;30(3):337–42. https://doi.org/10.1097/ACO.0000000000000461.CrossRefPubMed

24.

Earley MA, Pham LT, April MM. Scoping review: awareness of neurotoxicity from anesthesia in children in otolaryngology literature. Laryngoscope. 2017;127(8):1930–7. https://doi.org/10.1002/lary.26485.CrossRefPubMed

25.

Graham MR. Clinical update regarding general anesthesia-associated neurotoxicity in infants and children. Curr Opin Anaesthesiol. 2017;30(6):682–7. https://doi.org/10.1097/ACO.0000000000000520.CrossRefPubMed

26.

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. https://doi.org/10.1016/j.earlhumdev.2011.01.033.

Title: The effect of sevoflurane anesthesia for dental procedure on neurocognition in children: a prospective, equivalence, controlled trial
Authors: Pinping Zhou
Chao Zhang
Guijin Huang
Yuan Hu
Wenzhu Ma
Cong Yu
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Local Anesthesia in Dentistry
General Anesthesia
Sevoflurane
Caries
Published in: BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-02649-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of sevoflurane anesthesia for dental procedure on neurocognition in children: a prospective, equivalence, controlled trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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