Multiple General Anesthesia in Children: A Systematic Review of Its Effect on Neurodevelopment

Area of Science:

• Pediatric Anesthesiology
• Developmental Neuroscience
• Public Health

Background:

• Multiple general anesthesia (mGA) in early life is a growing concern, prompting regulatory alerts.
• Understanding the neurodevelopmental impact of mGA in children under four is critical.

Purpose of the Study:

• To systematically review the literature on the neurodevelopmental effects of mGA in children under four years of age.
• To synthesize evidence regarding potential risks associated with early-life exposure to mGA.

Main Methods:

• A systematic literature search was conducted across Medline, Embase, and Web of Science databases up to March 31, 2021.
• Included studies focused on pediatric patients under four years undergoing mGA, excluding case reports, animal studies, and expert opinions.
• Ten studies, assessing over 275,000 children (11,027 exposed), were included in the final analysis.

Main Results:

• The majority of included studies indicated a potential association between mGA before age four and neurodevelopmental delay.
• Only one study found no statistically significant difference in neurodevelopmental outcomes between exposed and unexposed children.
• A significant cohort size suggests a potential trend towards increased neurodevelopmental risks.

Conclusions:

• Evidence from controlled studies suggests that children receiving mGA before the age of four may face a heightened risk of neurodevelopmental delay.
• These findings underscore the importance of careful risk-benefit assessments for pediatric patients requiring multiple anesthetic exposures.
• Further research may be warranted to fully elucidate the long-term neurodevelopmental consequences of early-life mGA.