A Retrospective Cohort Study of the Association of Anesthesia and Hernia Repair Surgery With Behavioral and Developmental Disorders in Young Children

DiMaggio, Charles; Sun, Lena S.; Kakavouli, Athina; Byrne, Mary; Li, Guohua

doi:10.1097/ana.0b013e3181a71f11

Cited by 453 publications

(349 citation statements)

References 17 publications

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“…48 DiMaggio et al, using a New York State Medicaid database, showed that children younger than 3 years who were given general anesthesia for inguinal hernia repair had a greater than twofold risk of developmental or behavioral disorders than did agematched control children. 49 A potential bias of this study is that children undergoing surgery at a young age may also be predisposed to learning or cognitive disorders. Bartels et al attempted to address this issue by using the Netherlands Twin Registry to evaluate monozygotic concordant-discordant twins.…”

Section: Rationale and Timing For Elective Inguinal Hernia Repair In mentioning

confidence: 94%

Assessment and Management of Inguinal Hernia in Infants

Wang¹,

Papile²,

Baley³

et al. 2012

Pediatrics

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Inguinal hernia repair in infants is a routine surgical procedure. However, numerous issues, including timing of the repair, the need to explore the contralateral groin, use of laparoscopy, and anesthetic approach, remain unsettled. Given the lack of compelling data, consideration should be given to large, prospective, randomized controlled trials to determine best practices for the management of inguinal hernias in infants.

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Section: Rationale and Timing For Elective Inguinal Hernia Repair In mentioning

confidence: 94%

Assessment and Management of Inguinal Hernia in Infants

Wang¹,

Papile²,

Baley³

et al. 2012

Pediatrics

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“…However, variations in these human study approaches such as different assessment tools have led to inconsistent conclusions; some groups reported cognitive impairment (DiMaggio et al. 2009, 2011; Sprung et al. 2009; Wilder et al.…”

Section: Introductionmentioning

confidence: 99%

Early‐life single‐episode sevoflurane exposure impairs social behavior and cognition later in life

et al. 2016

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BackgroundSingle‐episode anesthetic exposure is the most prevalent surgery‐related incidence among young children in the United States. Although numerous studies have used animals to model the effects of neonatal anesthetics on behavioral changes later on in life, our understanding of the functional consequences to the developing brain in a comprehensive and clinically relevant manner is unclear.MethodsThe volatile anesthetic, sevoflurane (sevo) was administered to C57BL6 postnatal day 7 (P7) mice in a 40% oxygen and 60% nitrogen gas mixture. In order to examine the effects of sevo alone on the developing brain in a clinically relevant manner, mice were exposed to an average of 2.38 ± 0.11% sevo for 2 h. No sevo (control) mice were treated in an identical manner without sevo exposure. Mice were examined for cognition and neuropsychiatric‐like behavioral changes at 1–5 months of age.ResultsUsing the active place avoidance (APA) test and the novel object recognition (NOR) test, we demonstrated that P7 sevo‐treated mice showed a deficit in learning and memory both during periadolescence and adulthood. We then employed a battery of neuropsychiatric‐like behavioral tests to examine social interaction, communication, and repetitive behavior. Interestingly, compared to the no‐sevo–treated group, sevo‐treated mice showed significant reductions in the time interacting with a novel mouse (push–crawl and following), time and interaction in a chamber with a novel mouse, and time sniffing a novel social odor.ConclusionsOur study established that single‐episode, 2‐h sevo treatment during early life impairs cognition later on in life. With this approach, we also observed neuropsychiatric‐like behavior changes such as social interaction deficits in the sevo‐treated mice. This study elucidated the effects of a clinically relevant single‐episode sevo application, given during the neonatal period, on neurodevelopmental behavioral changes later on in life.

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“…12 Findings from clinical studies are mixed, with some studies showing a twofold increase in cognitive disability in children with anesthetic exposure, whereas others show no association. [13][14][15][16][17][18][19][20] In studies demonstrating an association of anesthesia with disability, only children with multiple anesthetic exposures have been associated with deficits, but an effect with a single exposure has not been identified. 14,18,20 These clinical studies have used International Classification of Diseases, 9th Revision diagnosis codes, standardized tests, and evaluations by parents and teachers as outcome measures, but none to date has used a battery of multiple directly assessed neuropsychological outcome measures.…”

mentioning

confidence: 99%

Long-term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia

Ing¹,

DiMaggio

Whitehouse³

et al. 2012

Pediatrics

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562

408

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BACKGROUND: Over the past decade, the safety of anesthetic agents in children has been questioned after the discovery that immature animals exposed to anesthesia display apoptotic neurodegeneration and long-term cognitive deficiencies. We examined the association between exposure to anesthesia in children under age 3 and outcomes in language, cognitive function, motor skills, and behavior at age 10. METHODS: We performed an analysis of the Western Australian Pregnancy Cohort (Raine) Study, which includes 2868 children born from 1989 to 1992. Of 2608 children assessed, 321 were exposed to anesthesia before age 3, and 2287 were unexposed. RESULTS: On average, exposed children had lower scores than their unexposed peers in receptive and expressive language (Clinical Evaluation of Language Fundamentals: Receptive [CELF-R] and Expressive [CELF-E]) and cognition (Colored Progressive Matrices [CPM]). After adjustment for demographic characteristics, exposure to anesthesia was associated with increased risk of disability in language (CELF-R: adjusted risk ratio [aRR], 1.87; 95% confidence interval [CI], 1.20–2.93, CELF-E: aRR, 1.72; 95% CI, 1.12–2.64), and cognition (CPM: aRR, 1.69; 95% CI, 1.13–2.53). An increased aRR for disability in language and cognition persisted even with a single exposure to anesthesia (CELF-R aRR, 2.41; 95% CI, 1.40–4.17, and CPM aRR, 1.73; 95% CI, 1.04–2.88). CONCLUSIONS: Our results indicate that the association between anesthesia and neuropsychological outcome may be confined to specific domains. Children in our cohort exposed to anesthesia before age 3 had a higher relative risk of language and abstract reasoning deficits at age 10 than unexposed children.

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A Retrospective Cohort Study of the Association of Anesthesia and Hernia Repair Surgery With Behavioral and Developmental Disorders in Young Children

Cited by 453 publications

References 17 publications

Assessment and Management of Inguinal Hernia in Infants

Assessment and Management of Inguinal Hernia in Infants

Early‐life single‐episode sevoflurane exposure impairs social behavior and cognition later in life

Long-term Differences in Language and Cognitive Function After Childhood Exposure to Anesthesia

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