Cognitive outcome after spinal anesthesia and surgery during infancy

Robert K. Williams, Ian H. Black, Diantha B. Howard, David C. Adams, Donald M. Mathews, Alexander F. Friend, H. W Bud Meyers

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)651-660
Number of pages10
JournalAnesthesia and Analgesia
Volume119
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Spinal Anesthesia
Mathematics
Reading
General Anesthesia
Anesthesia
Odds Ratio
Confidence Intervals
Students
Inguinal Hernia
Herniorrhaphy
Social Class
Cognition
Observational Studies
Databases
Pediatrics
Education
Population

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Williams, R. K., Black, I. H., Howard, D. B., Adams, D. C., Mathews, D. M., Friend, A. F., & Meyers, H. W. B. (2014). Cognitive outcome after spinal anesthesia and surgery during infancy. Anesthesia and Analgesia, 119(3), 651-660. https://doi.org/10.1213/ANE.0000000000000288

Cognitive outcome after spinal anesthesia and surgery during infancy. / Williams, Robert K.; Black, Ian H.; Howard, Diantha B.; Adams, David C.; Mathews, Donald M.; Friend, Alexander F.; Meyers, H. W Bud.

In: Anesthesia and Analgesia, Vol. 119, No. 3, 01.01.2014, p. 651-660.

Research output: Contribution to journalArticle

Williams, RK, Black, IH, Howard, DB, Adams, DC, Mathews, DM, Friend, AF & Meyers, HWB 2014, 'Cognitive outcome after spinal anesthesia and surgery during infancy', Anesthesia and Analgesia, vol. 119, no. 3, pp. 651-660. https://doi.org/10.1213/ANE.0000000000000288
Williams, Robert K. ; Black, Ian H. ; Howard, Diantha B. ; Adams, David C. ; Mathews, Donald M. ; Friend, Alexander F. ; Meyers, H. W Bud. / Cognitive outcome after spinal anesthesia and surgery during infancy. In: Anesthesia and Analgesia. 2014 ; Vol. 119, No. 3. pp. 651-660.
@article{4d5fb52fbb254392ac02b121838d8652,
title = "Cognitive outcome after spinal anesthesia and surgery during infancy",
abstract = "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.",
author = "Williams, {Robert K.} and Black, {Ian H.} and Howard, {Diantha B.} and Adams, {David C.} and Mathews, {Donald M.} and Friend, {Alexander F.} and Meyers, {H. W Bud}",
year = "2014",
month = "1",
day = "1",
doi = "10.1213/ANE.0000000000000288",
language = "English (US)",
volume = "119",
pages = "651--660",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Cognitive outcome after spinal anesthesia and surgery during infancy

AU - Williams, Robert K.

AU - Black, Ian H.

AU - Howard, Diantha B.

AU - Adams, David C.

AU - Mathews, Donald M.

AU - Friend, Alexander F.

AU - Meyers, H. W Bud

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84906939359&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906939359&partnerID=8YFLogxK

U2 - 10.1213/ANE.0000000000000288

DO - 10.1213/ANE.0000000000000288

M3 - Article

C2 - 24914628

AN - SCOPUS:84906939359

VL - 119

SP - 651

EP - 660

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 3

ER -