Longitudinal associations between exposure to anesthesia and neurocognitive functioning in pediatric medulloblastoma.

Abstract

AIM\nTo examine whether anesthesia exposure is associated with neurocognitive decline in pediatric medulloblastoma.\n\n\nMETHODS\nPatients were treated at St. Jude Children s Research Hospital and completed ≥2 protocol-directed neurocognitive assessments (n\xa0=\xa0107)\xa0as part of a multisite clinical trial for pediatric medulloblastoma (NCT00085202). Patients received risk-adapted craniospinal photon irradiation, followed by four cycles of high-dose chemotherapy and stem cell rescue. Neurocognitive testing was completed at study baseline (after surgery and <2 weeks of starting radiation therapy) and annually for 5 years. Data on anesthesia exposure during treatment was abstracted from medical records.\n\n\nRESULTS\nPatients were 10.2\xa0years at diagnosis on average (SD\xa0=\xa04.5; 37% female, 73% average-risk). Mean cumulative anesthesia duration was 20.4\xa0h (SD\xa0=\xa015.2; range 0.7-55.6\xa0h). In the overall group, longer anesthesia duration was associated with greater declines in IQ (Estimate\xa0=\xa0-0.08, P\xa0<\xa00.001), attention (Estimate\xa0=\xa0-0.10, P\xa0<\xa0.001)\xa0and processing speed (Estimate\xa0=\xa0-0.13, P\xa0<\xa00.001). Similar results were shown in subgroups of patients who were <7\xa0years at diagnosis (IQ\xa0=\xa0-0.14, P\xa0=\xa00.027; Attention\xa0=\xa0-0.25: P\xa0=\xa00.011), ≥7\xa0years at diagnosis (Attention\xa0=\xa0-0.07, P\xa0=\xa00.039; Processing Speed\xa0=\xa0-0.08, P\xa0=\xa00.022), treated for high-risk disease (IQ\xa0=\xa0-0.09, P\xa0=\xa00.024; Attention\xa0=\xa0-0.11, P\xa0=\xa00.034; Processing Speed\xa0=\xa0-0.13, P\xa0=\xa00.001), or treated for average-risk disease (IQ\xa0=\xa0-0.05, P\xa0=\xa0.022; Attention\xa0=\xa0-0.08, P\xa0=\xa00.011; Processing Speed\xa0=\xa0-0.10, P\xa0<\xa00.001).\n\n\nCONCLUSION\nGreater anesthesia exposure is a risk factor for clinically significant neurocognitive decline, in addition to factors of age at diagnosis and treatment risk arm. This result is notable as there are evidence-based strategies that can limit the need for anesthesia. Limiting anesthesia exposure, as feasible, may mitigate neurocognitive late effects, and thus, improve quality of life for survivors.