Anesthesia Exposure during Therapy Predicts Neurocognitive Outcomes in Survivors of Childhood Medulloblastoma

Jacola, Lisa M.; Anghelescu, Doralina L.; Hall, Lacey; Russell, Kathryn; Zhang, Hui; Wang, Fang; Peters, Joanna B.; Rossi, Michael; Schreiber, Jane E.; Gajjar, Amar

doi:10.1016/j.jpeds.2020.04.039

Cited by 24 publications

(16 citation statements)

References 35 publications

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“…Detailed mean cumulative duration of GA was recorded in 27 studies, ranging diffusely from <45 min to 21.1 h (Poor Zamany Nejat Kermany et al, 2016 ; Jacola et al, 2020 ). Seventeen studies referred to a relatively short or moderate length shorter than 2 h. Eight of these provided evidence supporting malign results induced by GA under such circumstances, while the other nine gave opposite findings.…”

Section: Resultsmentioning

confidence: 99%

General anesthesia in children and long-term neurodevelopmental deficits: A systematic review

Xiao

Yang

et al. 2022

Front. Mol. Neurosci.

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BackgroundMillions of children experienced surgery procedures requiring general anesthesia (GA). Any potential neurodevelopmental risks of pediatric anesthesia can be a serious public health issue. Various animal studies have provided evidence that commonly used GA induced a variety of morphofunctional alterations in the developing brain of juvenile animals.MethodsWe conducted a systematic review to provide a brief overview of preclinical studies and summarize the existing clinical studies. Comprehensive literature searches of PubMed, EMBASE, CINAHL, OVID Medline, Web of Science, and the Cochrane Library were conducted using the relevant search terms “general anesthesia,” “neurocognitive outcome,” and “children.” We included studies investigating children who were exposed to single or multiple GA before 18, with long-term neurodevelopment outcomes evaluated after the exposure(s).ResultsSeventy-two clinical studies originating from 18 different countries published from 2000 to 2022 are included in this review, most of which are retrospective studies (n = 58). Two-thirds of studies (n = 48) provide evidence of negative neurocognitive effects after GA exposure in children. Neurodevelopmental outcomes are categorized into six domains: academics/achievement, cognition, development/behavior, diagnosis, brain studies, and others. Most studies focusing on children <7 years detected adverse neurocognitive effects following GA exposure, but not all studies consistently supported the prevailing view that younger children were at greater risk than senior ones. More times and longer duration of exposures to GA, and major surgeries may indicate a higher risk of negative outcomes.ConclusionBased on current studies, it is necessary to endeavor to limit the duration and numbers of anesthesia and the dose of anesthetic agents. For future studies, we require cohort studies with rich sources of data and appropriate outcome measures, and carefully designed and adequately powered clinical trials testing plausible interventions in relevant patient populations.

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Section: Resultsmentioning

confidence: 99%

General anesthesia in children and long-term neurodevelopmental deficits: A systematic review

Xiao

Yang

et al. 2022

Front. Mol. Neurosci.

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“…The inclusion of sedation and general anaesthesia in paediatric radiotherapy makes it riskier and more difficult for the patient and radiotherapist, respectively [43 , 44] . Reconsidering the use of general anaesthesia and sedation to when it truly is a must is indicated in the literature [45] .…”

Section: Category 2: Advancing the Practical Infrastructural Areas Of...mentioning

confidence: 99%

The lived experiences of radiotherapists treating paediatric patients: Gauteng, South Africa

Siddique

Bhyat

Lewis

2022

Journal of Medical Imaging and Radiation Sciences

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“…Literature in children is conflicting, with studies showing no relation between exposure to sedatives 23 , analgesics 23 and anesthetics 24-27 and neurocognitive outcomes, while other studies do report negative relations with exposure to sedatives 28 , analgesics 29 and anesthetics 30-33 . Moreover, the available literature is challenged by the unknown contribution of the underlying disease in the observed relations between drug exposure and neurocognitive outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Literature in children is conflicting, with studies showing no relation between exposure to sedatives 23 , analgesics 23 and anesthetics [24][25][26][27] and neurocognitive outcomes, while other studies do report negative relations with exposure to sedatives 28 , analgesics 29 and anesthetics [30][31][32][33] .…”

Section: Introductionmentioning

confidence: 99%

Long-term Neurocognitive Outcomes after Pediatric Intensive Care Unit Admission: Exploring the Role of Drug Exposure

Sonnaville

Oosterlaan

Ghiassi

et al. 2022

Preprint

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Introduction: Concerns exist regarding the impact of widely-used clinical drugs on brain development. This study investigates long-term neurocognitive functioning in relation to frequently used drug exposure at the Pediatric Intensive Care Unit (PICU). Methods: This study compared children aged 6-12 years with previous PICU admission (age </=1 year) for bronchiolitis requiring mechanical ventilation (patient group, n=65) to a demographically comparable control group (n=76) on a broad range of neurocognitive outcomes. The patient group was selected because bronchiolitis seldom manifests neurologically and is therefore not expected to affect neurocognitive functioning in itself. The relation between exposure to sedatives, analgesics and anesthetics and neurocognitive outcomes was assessed by regression analyses. Results: The patient group had lower intelligence than the control group (p<.001, d=-0.59) and poorer performance in neurocognitive functions; i.e. speed and attention (p=.009, d=-0.41) and verbal memory (p<.001, d=-0.60). Exposure to sedatives, analgesics and anesthetics was not related to neurocognitive outcomes. Conclusion: Children with PICU admission for bronchiolitis requiring mechanical ventilation are at risk of long-term neurocognitive impairment. This study found no evidence for a role of exposure to sedatives, analgesics or anesthetics. Findings underline the importance of long-term follow-up after PICU admission, even in absence of disease with neurological manifestation.

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Anesthesia Exposure during Therapy Predicts Neurocognitive Outcomes in Survivors of Childhood Medulloblastoma

Cited by 24 publications

References 35 publications

General anesthesia in children and long-term neurodevelopmental deficits: A systematic review

General anesthesia in children and long-term neurodevelopmental deficits: A systematic review

The lived experiences of radiotherapists treating paediatric patients: Gauteng, South Africa

Long-term Neurocognitive Outcomes after Pediatric Intensive Care Unit Admission: Exploring the Role of Drug Exposure

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