From the *Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Yong Loo Lin School of Medicine; and †Centre for Qualitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
Anesth Analg. 2013 Dec;117(6):1419-28. doi: 10.1213/ANE.0b013e318299a7c2.
Recent evidence from juvenile animal models has shown that exposure to anesthetic drugs above threshold doses during a critical neurodevelopmental window causes widespread neuronal apoptosis, resulting in irreversible brain damage and subsequent learning difficulties. The relevance of this to human infants having general anesthesia for minor surgery is unknown. In this pilot observational cohort study, we sought to determine whether children exposed to general anesthesia for minor surgery during infancy exhibited differences in academic achievement at age 12 years, as evidenced by (1) lower aggregate scores in the Singapore standardized Primary School Leaving Examination (PSLE) and (2) formally diagnosed learning disability, compared with children who were never exposed to anesthesia or sedation.
We compared 100 full-term, apparently healthy children aged 12 years who were exposed to general anesthesia for minor surgery before age 1 at our institution with an age-matched cohort of 106 children who were never exposed to anesthesia or sedation. Parents of children completed a 20-minute telephone interview with questions regarding their children's medical history, school environment, and home environment.
The difference in mean PSLE aggregate scores (3.0; 95% confidence interval [CI], -8.3 to 14.3) between exposed (197.0; 95% CI, 185.6-208.4) and control groups (194.0; 95% CI, 182.9-205.1) was not statistically significant (P = 0.603). The presence of formally diagnosed learning disability was 15% (15 of 100) in the exposed group compared with 3.77% (4 of 106) in the control group (P < 0.001). The odds ratio for a formal diagnosis of learning disability in those exposed to general anesthesia relative to controls was 4.5 (95% CI, 1.44-14.1).
The odds of a formal diagnosis of learning disability by age 12 years in apparently healthy children exposed to general anesthesia for minor surgery during infancy were 4.5 times greater than their peers who had never been exposed to anesthesia. However, study precision was inadequate to detect a clinically relevant difference in PSLE scores.
最近，来自幼年动物模型的证据表明，在关键的神经发育窗口期内，接触高于阈值剂量的麻醉药物会导致广泛的神经元凋亡，从而导致不可逆转的脑损伤和随后的学习困难。这种情况与婴儿因小手术而全身麻醉的相关性尚不清楚。在这项初步观察性队列研究中，我们试图确定在婴儿期因小手术而接受全身麻醉的儿童在 12 岁时的学业成绩是否存在差异，其证据为：(1) 在新加坡标准化小学离校考试(PSLE)中的综合分数较低，以及 (2) 与从未接受过麻醉或镇静的儿童相比，正式诊断为学习障碍。
我们比较了 100 名在我们机构接受过 1 岁前全身麻醉治疗的足月、健康的 12 岁儿童与未接受过麻醉或镇静的 106 名年龄匹配的儿童。儿童的父母完成了一项 20 分钟的电话访谈，内容包括他们孩子的病史、学校环境和家庭环境。
暴露组(197.0;95%置信区间[CI]，-8.3 至 14.3)和对照组(194.0;95%CI，182.9 至 205.1)的 PSLE 综合评分差异的平均值为 3.0(95%CI，-8.3 至 14.3)，差异无统计学意义(P=0.603)。暴露组中正式诊断为学习障碍的比例为 15%(15/100)，对照组为 3.77%(4/106)(P<0.001)。与对照组相比，接受全身麻醉的儿童中正式诊断为学习障碍的比值比为 4.5(95%CI，1.44-14.1)。
在因小手术而接受全身麻醉的健康婴儿中，到 12 岁时正式诊断为学习障碍的可能性是从未接受过麻醉的同龄人的 4.5 倍。然而，研究精度不足以检测到 PSLE 分数的临床相关差异。
