Does general anesthesia affect neurodevelopment in infants and children?

McCann, Mary Ellen; Soriano, Sulpicio G.

doi:10.1136/bmj.l6459

Cited by 135 publications

(105 citation statements)

References 105 publications

(114 reference statements)

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“…There is considerable interest and some concern over the potential risk of general anesthesia, volatile anesthetics in particular, on the developing brain [1][2][3][4]. This potential for neurocognitive effects led the Food and Drug Administration (FDA) to release a Safety Statement in 2017, approving label changes for general anesthetics in young children.…”

Section: Introductionmentioning

confidence: 99%

The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

Sullivan

Egbuta

Park

et al. 2020

JCM

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The exposure of infants and children to volatile anesthetics, such as sevoflurane, has been a topic of concern with respect to the potential risk for long term neurocognitive effects. The primary objective of this study was to determine whether the perioperative utilization of Bispectral Index (BIS) monitoring alters the sevoflurane delivery and exposure to children. This is a prospective randomized trial of two groups of healthy ambulatory day surgery patients (2 to 12 years). The patients in both groups had the BIS applied soon after the induction of general anesthesia, but only the anesthesiologists in the group randomized to BIS visible were able to see the BIS values. All of the patients received general anesthesia with sevoflurane. This study found no difference in the overall exposure to sevoflurane between both groups (mean end-tidal sevoflurane level of 1.8 in both groups, P = 084). The duration of time in the recovery room, the time to meet discharge criteria, the Pediatric Agitation Emergence Delirium (PAED) scores and the Face, Legs, Activity, Cry, Consolability (FLACC) scores were not statistically different between the groups. The application and utilization of intraoperative BIS monitoring does not alter the sevoflurane administration nor the discharge readiness nor the recovery profile in healthy ambulatory children.

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Section: Introductionmentioning

confidence: 99%

The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

Sullivan

Egbuta

Park

et al. 2020

JCM

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“…A preponderance of basic science and animal model studies [43][44][45][46] have demonstrated the neurotoxic and neurological effects of commonly used medications for moderate sedation and general anesthesia. Ongoing clinical trials 21,25 have not supported an association between single anesthetic exposure and general intelligence or learning, but there is evidence suggesting that multiple exposures may decrease neuropsychological domains affecting executive functioning. 25,47 The US Food and Drug Administration approved a label change regarding possible neurotoxic effects of general anesthetic and sedation medications in children younger than 3 years, warning that "exposure to these medicines for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years."…”

Section: Discussionmentioning

confidence: 99%

“…Ongoing clinical trials 21,25 have not supported an association between single anesthetic exposure and general intelligence or learning, but there is evidence suggesting that multiple exposures may decrease neuropsychological domains affecting executive functioning. 25,47 The US Food and Drug Administration approved a label change regarding possible neurotoxic effects of general anesthetic and sedation medications in children younger than 3 years, warning that "exposure to these medicines for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years." 20 Beyond potential adverse clinical outcomes, reducing dental surgical procedures has immediate financial implications for health care systems.…”

Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Analysis of Community Water Fluoridation and Prevalence of Pediatric Dental Surgery Among Medicaid Enrollees

2020

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IMPORTANCE Dental surgery under general anesthesia (DGA) is an ineffective, costly treatment for caries. Interventions to reduce the need for DGA are challenging because children's parents may not seek care until surgery is required. Community water fluoridation (CWF) effectively prevents early childhood caries, but its effectiveness in reducing severe early childhood caries is unknown. OBJECTIVE To determine whether access to CWF is associated with the prevalence of DGA. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional analysis of Medicaid claims data from 2011 to 2012. Deidentified data were derived from Medicaid claims and enrollee files for Massachusetts, Texas, Connecticut, Illinois, and Florida for children aged 9 years and younger enrolled in either a fee-for-service or managed care plan through their state's Medicaid program. Linear regression models tested for associations between CWF and covariates. Multivariable linear regression models tested for associations between CWF and outcomes. Regression models included clustered SEs at the county level. Data analysis was performed from December 2018 to March 2020. EXPOSURES Access to CWF was determined by estimating the proportion of a county's total population that had access to a fluoridated public water system. MAIN OUTCOMES AND MEASURES The main outcome was county-level DGA prevalence. Other outcomes were caries-related visit prevalence and patient quality indicators (asthma and diabetes). Covariates included county-level demographic, socioeconomic, and dental practitioner variables. RESULTS A total of 436 counties within 5 states per year (872 county-year observations), were included in the analysis. Adjusted analysis revealed that a 10% increase in the proportion of county's population access to CWF was associated with lower caries-related visit prevalence (−0.45 percentage points; 95% CI, −0.59 to −0.31 percentage points; P < .001). Increasing CWF access in 10% increments was associated with decreased DGA prevalence in unadjusted analysis (−0.39 percentage points; 95% CI, −0.67 to −0.12 percentage points; P = .006) but not in adjusted analysis (−0.23 percentage points; 95% CI, −0.49 to 0.02 percentage points; P = .07). Increasing the proportion of county's access to CWF by 10% was not associated with the prevalence of asthmarelated exacerbations (−0.02 percentage points; 95% CI, −0.10 to 0.05 percentage points; P = .53) or diabetes-related exacerbations (−0.0003 percentage points; 95% CI, −0.0014 to 0.0009 percentage points; P = .66). CONCLUSIONS AND RELEVANCE This study extends our understanding of CWF's benefits for children's oral health. Specifically, these findings suggest that increasing a population's access to CWF's is associated with decreased caries-related visits and may also be associated with use of dental surgical services within high-risk populations.

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“…However, propofol is still an off-label choice in most clinical pediatric practices (Chidambaran et al, 2015). The current dilemma is that there is a lack of evidence to support the safe use of propofol and there are a growing number of pre-clinical studies attributing neurotoxicity and neurogenic impairment to propofol (Krzisch et al, 2013;Bosnjak et al, 2016;McCann and Soriano, 2019).…”

Section: Introductionmentioning

confidence: 99%

Propofol Exposure Disturbs the Differentiation of Rodent Neural Stem Cells via an miR-124-3p/Sp1/Cdkn1b Axis

Cao

Zeng

et al. 2020

Front. Cell Dev. Biol.

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Accumulating studies have indicated that propofol may lead to neurotoxicity and its effect on neural stem cells (NSCs) may play pivotal role in propofol-related neurotoxicity. Previously, we found that propofol could promote NSCs proliferation and could regulate several microRNA expressions. However, the underlying mechanism between microRNAs and NSCs development after propofol exposure is still unclear. Our data first observed that rat primary neural stem cells exposed to propofol exhibited a cell cycle arrest status and an inclination to differentiate into GFAP + or S100β + cells. This phenomenon was accompanying with a lower miR-124-3p expression and could be reversed via overexpression miR-124-3p in NSCs. Using bioinformatic predictions and luciferase assay we confirmed that Sp1 (Specificity Protein 1) is the target gene of miR-124-3p, indicating that miR-124-3p may regulate NSCs development through Sp1. Further, knockdown of Sp1 rescue the effect of propofol on NSCs differentiation. Finally, we demonstrated that Sp1 could bind cdkn1b promoter region through chromatin immunoprecipitation assay, indicating that Sp1 affect NSC's cell cycle through cdkn1b directly. Overall, our study highlights the miR-124-3p/Sp1/cdkn1b axis to be important in propofol interfering the differentiation of NSCs.

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Does general anesthesia affect neurodevelopment in infants and children?

Cited by 135 publications

References 105 publications

The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

The Use of Bispectral Index Monitoring Does Not Change Intraoperative Exposure to Volatile Anesthetics in Children

A Cross-Sectional Analysis of Community Water Fluoridation and Prevalence of Pediatric Dental Surgery Among Medicaid Enrollees

Propofol Exposure Disturbs the Differentiation of Rodent Neural Stem Cells via an miR-124-3p/Sp1/Cdkn1b Axis

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