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Published on: December 7, 2012
Cognitive outcome after spinal anesthesia and surgery during infancy
Robert K Williams1, Ian H Black, Diantha B Howard
1From the Department of Anesthesiology, Vermont Children's Hospital; †Department of Anesthesiology, Fletcher Allen Health Care; ‡Center for Clinical and Translational Science, University of Vermont; and §James M. Jeffords Center for Policy Research, University of Vermont, Burlington, Vermont.
Insights
Infant spinal anesthesia (SA) and surgery duration did not impact academic achievement or very poor academic achievement (VPAA) in elementary students. A small decrease in reading and math scores was observed in the SA group.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Pediatrics
- Pediatric Surgery
Background:
- General anesthesia (GA) concerns in pediatrics are confounded by surgical need.
- Previous studies linked GA duration to lower test scores in children.
- A subgroup with very poor academic achievement (VPAA) was identified.
Purpose of the Study:
- To investigate the long-term effects of spinal anesthesia (SA) on academic achievement in children.
- To differentiate anesthesia effects from surgical factors in pediatric neurodevelopment.
- To assess the association between infant SA exposure and VPAA.
Main Methods:
- A novel database linked medical and educational records for 265 students exposed to SA in infancy.
- Students receiving SA for specific procedures were compared to a matched control group.
- Academic performance on standardized tests was analyzed.
Main Results:
- Infant SA and surgery duration showed no significant effect on VPAA.
- No relationship was found between SA exposure duration and math or reading scores.
- A small, statistically significant decrease in reading and math scores was noted in the SA-exposed group.
Conclusions:
- Infant SA exposure was not linked to VPAA in elementary school children.
- No association was found between SA duration and academic achievement.
- While VPAA was not linked, a slight score decrease warrants further investigation.
Background:
Observational studies on pediatric anesthesia neurotoxicity have been unable to distinguish long-term effects of general anesthesia (GA) from factors associated with the need for surgery. A recent study on elementary school children who had received a single GA during the first year of life demonstrated an association in otherwise healthy children between the duration of anesthesia and diminished test scores and also revealed a subgroup of children with "very poor academic achievement" (VPAA), scoring below the fifth percentile on standardized testing. Analysis of postoperative cognitive function in a similar cohort of children anesthetized with an alternative to GA may help to begin to separate the effects of anesthesia from other confounders.
Methods:
We used a novel methodology to construct a combined medical and educational database to search for these effects in a similar cohort of children receiving spinal anesthesia (SA) for the same procedures. We compared former patients with a control population of students matched by grade, gender, year of testing, and socioeconomic status.
Results:
Vermont Department of Education records were analyzed for 265 students who had a single exposure to SA during infancy for circumcision, pyloromyotomy, or inguinal hernia repair. Exposure to SA and surgery had no significant effect on the odds of children having VPAA. (mathematics: P = 0.18; odds ratio 1.50, confidence interval (CI), 0.83-2.68; reading: P = 0.55; odds ratio = 1.19, CI, 0.67-2.1). There was no relationship between duration of exposure to SA and surgery and performance on mathematics (P = 0.73) or reading (P = 0.57) standardized testing. There was a small but statistically significant decrease in reading and math scores in the exposed group (mathematics: P = 0.03; reading: P = 0.02).
Conclusions:
We found no link between duration of surgery with infant SA and scores on academic achievement testing in elementary school. We also found no relationship between infant SA and surgery with VPAA on elementary school testing, although the CIs were wide.
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