Science, Medicine, and the Anesthesiologist

Several human observational studies have found an association between exposure to anesthesia in early childhood and poorer neurobehavioral outcomes, with the association being stronger with multiple exposures. The impact of these studies is limited due to the strong likelihood of confounding. Randomized trials can mitigate the risk of confounding. This study enrolled children from a previously completed randomized trial in which infants with cystic fibrosis were randomized to multiple bronchoalveolar lavages under general anesthesia (n = 52) or standard of care (n = 45), up to 5 yr of age. The children received a battery of neurobehavioral tests and magnetic resonance imaging brain scans at a median age of 12.8 yr. The primary outcome was a composite score of performance on a standardized, computer-based assessment of child attention, processing speed, and response inhibition skills (Conners Continuous Performance test). By 5 yr of age, the bronchoalveolar lavage group had a median of six general anesthesia exposures while the standard of care arm had a median of two exposures. There was no difference in mean ± SD Conners score: 51 ± 8.1 in the bronchoalveolar lavage arm and 53 ± 8.8 in the standard of care arm with a difference –1.7 (95% CI, –5.2 to 1.7; P = 0.32). There was also no difference in other neurobehavioral measures and brain imaging.

Take home message: This randomized trial found that children exposed to a greater number of general anesthetics did not have different neurobehavioral outcomes compared to children exposed to fewer anesthetics.