Childhood Exposure to General Anesthesia For Surgery: Identification of a Subtle Post-Operative Cognitive Phenotype

Early-life exposure to general anesthesia has not been consistently associated with overall cognitive deficits, yet its impact on executive functions and visuo-spatial processing remains unclear. The primary objective was to assess executive function performance, according to general anesthesia exposure for surgery. The secondary objectives were to explore distinct cognitive profiles and their associated factors, as well as to examine visuo-spatial attention as a complementary domain.

In this ambidirectional cohort study, 77 children aged 9-11 years, with or without prior general anesthesia exposure for surgery, completed a cognitive battery yielding eight cognitive measures assessing inhibitory control, cognitive flexibility, working memory, and visuo-spatial attention. Measures were analyzed using a linear mixed-effects model. Exploratory latent profile analysis was used to identify cognitive performance profiles.

No significant main effect of general anesthesia exposure for surgery was observed (χ²(1) =.01, p =.92), indicating comparable overall executive function performance between exposed (mean age at exposure: 4.47 ± 3.00 years) and non-exposed. Latent profile analysis identified two executive function profiles: Efficient and Vulnerable Executive Control. General anesthesia exposure was associated with lower odds of belonging to the Efficient profile group (OR = 0.71, 95% CI [0.705, 0.710], p <.001). Regarding visuo-spatial attention, GA-exposed participants showed higher Global-Local precedence measures (estimate = 0.53, 95% CI [0.04, 1.01], p =.036).

Early childhood exposure to general anesthesia was not associated with reduced overall executive function. However, a potential post-operative cognitive phenotype is suggested by a reduced likelihood to belong to an efficient executive control profile with greater visuo-spatial global-local precedence.