Risk of Attention Deficit Hyper Activity Disorder After Early Exposure to General Anesthesia; A Case Control Study

Abstract

Background: Over the past decade, following the discovery that developing brain of immature animals was affected by anesthetic agents, the safety of general anesthesia (GA) in early life has been questioned. Objectives: We investigated the association between anesthesia exposure in children and ADHD development. Methods: This case-control study was conducted at pediatric psychology clinic of our institution and a pediatric neurology private clinic during 2019. Firstly the responsible resident of anesthesiology separated new ADHD cases. Then a questionnaire was filled out through an almost 10 minute’s telephone interview. Finally, frequency distribution of GA was compared between ADHD cases and controls. Results: Finally, the data from 210 children were analyzed. Among 105 ADHD cases, 19% had a history of a procedure requiring GA while it was 3.8% in control group. Comparing the two groups a significant difference was observed regarding the age of receiving GA (P = 0.004), gender (P < 0.001), the history of receiving GA (P = 0.001) and the number of anesthesia exposures (P = 0.001). According to logistic regression analysis, male gender (P = 0.001) OR 3.11 (95CI = 1.63 - 5.93) and age (P = 0.003) OR 0.92 (95CI = 0.87 - 0.97) were significant predictors of early exposure to GA and ADHD development. Conclusions: It was revealed that early exposure to GA might be a risk factor for later developing ADHD. Boys might be more sensitive to the long term adverse effects of anesthetic agents than girls. Further prospective well-planned studies are needed to confirm these findings.

Avoiding Unnecessary Exposure to General Anesthesia for Dental Treatments in the First Years of Life

“…I read the article entitled "Risk of attention deficit hyperactivity disorder after early exposure to general anesthesia; A case control study", by Sedighnejad et al (1), published in the third issue of the Iranian Journal of Pediatrics (2020) with great interest. The researchers concluded that early general anesthesia (GA) could be a predisposing factor for the subsequent development of attention deficit hyperactivity disorder (ADHD).…”

“…The researchers concluded that early general anesthesia (GA) could be a predisposing factor for the subsequent development of attention deficit hyperactivity disorder (ADHD). They found that a history of GA in children younger than four years of age was a significant predictor of ADHD (1). After reading this article, as a pedodontist, I was concerned about the longterm anesthetic-induced neurodevelopmental outcomes of common dental procedures under GA.…”

“…Generally, the advantages of pediatric GA, especially pain relief, anxiety reduction, and ideal surgical performance, which are prerequisites for an appropriate treat-ment or diagnostic intervention, are well-established (1,3). If experienced professionals adhere to scientific guidelines, treatments can be safely performed (7).…”

“…In this regard, previous studies have reported neurotoxicity induced by GA in immature animals (1-3). Generally, there are controversies about the safety of GA for the pediatric population (1, 3); however, it is difficult to confirm the significance of these findings in clinical practice (1). Also, considering the adverse effects of GA on the development of the central nervous system, it is difficult to determine the exact vulnerable age range and exposure time (1).…”

“…Also, over time and with age, developing nervous system still continues to be sensitive but less than first 2 years of life (3). According to one previous study, age below four years can be defined as the risky period for GA (1); overall, the critical time is the period of peak synaptogenesis (2). Anesthetic exposure may cause long-lasting apoptotic degeneration of the nervous system (1-3).…”