Brief general anaesthetic in infancy has no discernible neurodevelopmental impact

Abstract

Whether general anaesthesia in infancy is safe for the developing brain has been a long-standing issue of controversy, with animal data suggesting that cognitive, behavioural and memory deficits likely arise due to cellular toxicity of anaesthetic agents. A recent 28-centre, multinational trial of children undergoing inguinal hernia repair randomised 722 infants to either regional anaesthesia or general anaesthesia. To be included, participants had to be <15 months post-menstrual age, born at >26 weeks’ gestation and be naïve to previous general anaesthetic. Those with a history of congenital heart disease requiring treatment, known chromosomal abnormalities, perinatal benzodiazepine exposure or other medical disorder(s) impacting neurodevelopment were excluded. Most recruited participants were male (83%). The study found no statistically significant difference in the primary outcome of full-scale intelligence quotient score at 5 years of age between the placebo and intervention groups as determined by the Wechsler Preschool and Primary Scale of Intelligence (third edition), regardless of whether per-protocol or intention-to-treat analysis was used. There were also no significant differences in the results of a battery of other secondary outcome tests designed to assess attention, memory, behaviour and executive function. There was some loss to follow-up, with just under three quarters of participants assessed for the primary outcome. A key strength of the study was permission for the individual anaesthetist to control the concentration of sevoflurane, choice of airway device, ventilation technique and use of neuromuscular blocking agents, reflective of current natural variations in practice. The authors conclude that their multicentre randomised controlled trial provides strong evidence that just under 1 hour of general anaesthesia in infancy does not lead to the development of significant neurocognitive or behavioural deficits.