Are Anesthesia and Surgery during Infancy Associated with Decreased White Matter Integrity and Volume During Childhood?

• Published in: Anesthesiology (Philadelphia) Vol. 127; no. 5; pp. 788 - 799
• Main Authors: Block, Robert I., Magnotta, Vincent A., Bayman, Emine O., Choi, James Y., Thomas, Joss J., Kimble, Karolie K.
• Format: Journal Article
• Language: English
• Published: United States Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc 01.11.2017
• Subjects: Adolescent; Age Factors; Anesthesia - adverse effects; Anesthesia - trends; Child; Diffusion Magnetic Resonance Imaging - methods; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging - methods; Organ Size; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; White Matter - diagnostic imaging; White Matter - drug effects
• ISSN: 0003-3022; 1528-1175; 1528-1175
• DOI: 10.1097/ALN.0000000000001808

BACKGROUND:Anesthetics have neurotoxic effects in neonatal animals. Relevant human evidence is limited. We sought such evidence in a structural neuroimaging study. METHODS:Two groups of children underwent structural magnetic resonance imagingpatients who, during infancy, had one of four operations commonly performed in otherwise healthy children and comparable, nonexposed control subjects. Total and regional brain tissue composition and volume, as well as regional indicators of white matter integrity (fractional anisotropy and mean diffusivity), were analyzed. RESULTS:Analyses included 17 patients, without potential confounding central nervous system problems or risk factors, who had general anesthesia and surgery during infancy and 17 control subjects (age ranges, 12.3 to 15.2 yr and 12.6 to 15.1 yr, respectively). Whole brain white matter volume, as a percentage of total intracranial volume, was lower for the exposed than the nonexposed group, 37.3 ± 0.4% and 38.9 ± 0.4% (least squares mean ± SE), respectively, a difference of 1.5 percentage points (95% CI, 0.3 to 2.8; P = 0.016). Corresponding decreases were statistically significant for parietal and occipital lobes, infratentorium, and brainstem separately. White matter integrity was lower for the exposed than the nonexposed group in superior cerebellar peduncle, cerebral peduncle, external capsule, cingulum (cingulate gyrus), and fornix (cres) and/or stria terminalis. The groups did not differ in total intracranial, gray matter, and cerebrospinal fluid volumes. CONCLUSIONS:Children who had anesthesia and surgery during infancy showed broadly distributed, decreased white matter integrity and volume. Although the findings may be related to anesthesia and surgery during infancy, other explanations are possible.