Does Repeated Anesthesia Affect IQ in Children?

TOPLINE:

Multiple exposures to general anesthesia before age 5 years are linked to lower IQ, decreased verbal and perceptual skills, and increased behavioral issues in children.

METHODOLOGY:

• An international group of researchers conducted an observational study using data from the GAS trial carried out across seven countries, which compared infants who had received initial general anesthesia for elective inguinal herniorrhaphy with those who did not.
• The study aimed to assess the association between multiple exposures to anesthesia in early childhood and neurodevelopmental outcomes at 5 years of age.
• The analysis included 90 children with two or more exposures to general anesthesia and 141 with one or no exposure, all with complete assessments.
• The primary outcome was the full-scale intelligence quotient (FSIQ) score measured at age 5 using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition.
• The secondary outcomes included verbal and performance IQ scores, results of neurocognitive testing, and caregiver assessments of emotional and behavioral problems.

TAKEAWAY:

• Children with repeated exposure to general anesthesia scored, on average, 5.8 points lower in FSIQ than those with one or no exposure (P = .011).
• Multiple exposures were associated with decreased verbal (adjusted mean difference [aMD], −6.9; 95% CI, −11.3 to −2.5) and performance (aMD, −5.6; 95% CI, −10.3 to −1.0) IQ scores.
• Multiple anesthesia exposures were associated with increased difficulties in global executive function, as indicated by T scores that were 4.6 points higher on average (95% CI, 1.0-8.2).
• Increased emotional and behavioral difficulties were noted in children with multiple anesthesia exposures with consistently elevated T scores.

IN PRACTICE:

“[W]e found an association between multiple exposures to procedures requiring anesthesia under the age of 5 and reduced scores in general intelligence, verbal skills, perceptual organization and increased scores in maladaptive behavior at 5 years of age,” the authors of the study wrote. “However, our results need to be cautiously interpreted in the context of a small sample size due to missing data and unmeasured confounding. These results might be better interpreted as illustrative of the potential limitations of using existing datasets for secondary and post hoc analyses where the data may not be fit for purpose.”

SOURCE:

The study was led by Annie Xin, PhD, of The Royal Children’s Hospital in Melbourne, Australia. It was published online on November 11, 2024, in Anesthesiology.

LIMITATIONS:

Potential residual confounding may exist due to the observational nature of the study. The sample size was small, and complete information on the number of anesthetic exposures was not available. The study predominantly included boys, potentially affecting the generalizability of the findings.

DISCLOSURES:

The study was supported by institutional and departmental sources, along with additional funding from the Canadian Institutes of Health Research and the Canadian Anesthesiologists’ Society. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.