Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 152; no. 2; pp. 482 - 489
• Main Authors: Diaz, Laura K., MD, Gaynor, J. William, MD, Koh, Shannon J., BA, Ittenbach, Richard F., PhD, Gerdes, Marsha, PhD, Bernbaum, Judy C., MD, Zackai, Elaine H., MD, Clancy, Robert R., MD, Rehman, Mohamed A., MD, Pennington, Jeffrey W., BS, Burnham, Nancy, MSN, Spray, Thomas L., MD, Nicolson, Susan C., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: anesthesia; Cardiothoracic Surgery; congenital heart surgery; neurodevelopment; neurotoxicity; BSID-II; SES; NP; hypoplastic left heart syndrome; full-scale IQ; WPPSI-III; deep hypothermic circulatory arrest; CNS; general anesthesia; neurodevelopmental; anesthesia; AUC; AIMS; neurotoxicity; neurodevelopment; FSIQ; Apolipoprotein E; verbal IQ; cardiopulmonary bypass; GA; intensive care unit; APOE; performance IQ; minimum alveolar concentration hours; volatile anesthetic agents; HLHS; central nervous system; Wechsler Preschool and Primary Scale of Intelligence, 3rd edition; LOS; CPB; congenital heart surgery; ND; VAA; length of stay; PIQ; ICU; MAC-hrs; Bayley Scales of Infant Development-II; HC; head circumference; DHCA; socioeconomic status; Anesthesia Information Management System; area-under-the-curve; CHD; nasopharyngeal; congenital heart defects; VIQ
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2016.03.095

Abstract Objectives Despite improved survival in children with hypoplastic left heart syndrome (HLHS), significant concern persists regarding their neurodevelopmental (ND) outcomes. Previous studies have identified patient factors, such as prematurity and genetic syndromes, to be associated with worse ND outcomes. However, no consistent relationships have been identified among modifiable management factors, including cardiopulmonary bypass strategies, and ND outcomes after cardiac surgery in infancy. Studies in immature animals, including primates, have demonstrated neurodegeneration and apoptosis in the brain after certain levels and extended durations of anesthetic exposure. Retrospective human studies have also suggested relationships between adverse ND effects and anesthetic exposure. Methods Cumulative minimum alveolar concentration hours (MAC-hrs) of exposure to volatile anesthetic agents (VAA) (desflurane, halothane, isoflurane, and sevoflurane) were collected from an anesthetic database and medical record review for 96 patients with HLHS or variants. ND testing was performed between ages 4 and 5 years, including full-scale IQ, verbal IQ, performance IQ, and processing speed. Four generalized linear modes were hypothesized a priori and tested using a Gaussian (normal) distribution with an identity link. Results Cumulative VAA exposure ranged from 0 to 35.3 MAC-hrs (median 7.5 hours). Using specified covariates identified previously as significant predictors of ND outcomes, statistically significant relationships were identified between total MAC-hrs exposure and worse full-scale IQ and verbal IQ scores ( P 's < .05) alone and after adjusting for relevant covariates. Conclusions Increased cumulative MAC-hrs exposure to VAA is associated with worse ND outcomes in certain domains in children with HLHS and variants.