scholarly journals Anesthesia for Cesarean Delivery and Learning Disabilities in a Population-based Birth Cohort

2009 ◽  
Vol 111 (2) ◽  
pp. 302-310 ◽  
Author(s):  
Juraj Sprung ◽  
Randall P. Flick ◽  
Robert T. Wilder ◽  
Slavica K. Katusic ◽  
Tasha L. Pike ◽  
...  
Keyword(s):  
Learning Disabilities ◽  
General Anesthesia ◽  
Cesarean Delivery ◽  
Birth Cohort ◽  
Regional Anesthesia ◽  
Population Based ◽  
Perinatal Exposure ◽  
Neurodevelopmental Outcomes ◽  
Anesthetic Drugs

Background Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort. Methods The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia). Results Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia n = 193, and regional anesthesia n = 304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia before age 4 yr, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P = 0.017 for comparison of CD under regional anesthesia compared to vaginal delivery). Conclusion Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.

scholarly journals Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort

2017 ◽  
Vol 127 (2) ◽  
pp. 227-240 ◽  
Author(s):  
Danqing Hu ◽  
Randall P. Flick ◽  
Michael J. Zaccariello ◽  
Robert C. Colligan ◽  
Slavica K. Katusic ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Learning Disabilities ◽  
General Anesthesia ◽  
Cognitive Ability ◽  
Birth Cohort ◽  
Attention Deficit ◽  
Population Based ◽  
Neurodevelopmental Outcomes ◽  
Hyperactivity Disorder ◽  
Multiple Exposures

Abstract Background Exposure of young animals to general anesthesia causes neurodegeneration and lasting behavioral abnormalities; whether these findings translate to children remains unclear. This study used a population-based birth cohort to test the hypothesis that multiple, but not single, exposures to procedures requiring general anesthesia before age 3 yr are associated with adverse neurodevelopmental outcomes. Methods A retrospective study cohort was assembled from children born in Olmsted County, Minnesota, from 1996 to 2000 (inclusive). Propensity matching selected children exposed and not exposed to general anesthesia before age 3 yr. Outcomes ascertained via medical and school records included learning disabilities, attention-deficit/hyperactivity disorder, and group-administered ability and achievement tests. Analysis methods included proportional hazard regression models and mixed linear models. Results For the 116 multiply exposed, 457 singly exposed, and 463 unexposed children analyzed, multiple, but not single, exposures were associated with an increased frequency of both learning disabilities and attention-deficit/hyperactivity disorder (hazard ratio for learning disabilities = 2.17 [95% CI, 1.32 to 3.59], unexposed as reference). Multiple exposures were associated with decreases in both cognitive ability and academic achievement. Single exposures were associated with modest decreases in reading and language achievement but not cognitive ability. Conclusions These findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention. Although a robust association was observed, these data do not determine whether anesthesia per se is causal.

Anesthesia for Cesarean Delivery and Learning Disabilities in a Population-based Birth Cohort

2010 ◽  
Vol 30 (1) ◽  
pp. 2
Author(s):  
J. Sprung ◽  
R.P. Flick ◽  
R.T. Wilder ◽  
S.K. Katusic ◽  
T.L. Pike ◽  
...  
Keyword(s):  
Learning Disabilities ◽  
Cesarean Delivery ◽  
Birth Cohort ◽  
Population Based

Risk of Autism Associated With General Anesthesia During Cesarean Delivery: A Population-Based Birth-Cohort Analysis

2014 ◽  
Vol 45 (4) ◽  
pp. 932-942 ◽  
Author(s):  
Li-Nien Chien ◽  
Hsiu-Chen Lin ◽  
Yu-Hsuan Joni Shao ◽  
Shu-Ti Chiou ◽  
Hung-Yi Chiou
Keyword(s):  
General Anesthesia ◽  
Cesarean Delivery ◽  
Birth Cohort ◽  
Cohort Analysis ◽  
Population Based ◽  
Birth Cohort Analysis

scholarly journals Carotid Endarterectomy with Local Anesthesia and LMA/General Anesthesia

2014 ◽  
Author(s):  
Hani Annabi ◽  
Charles Fleischer ◽  
Robert Taylor ◽  
Steven Gruendling ◽  
joe pergolizzi ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Anesthetic Technique ◽  
Hybrid Technique ◽  
Comorbid Conditions ◽  
Neurological Assessment ◽  
Left Neck ◽  
Artery Disease

There is no clear consensus as to the appropriate anesthetic technique for patients undergoing a carotid endarterectomy. Such patients may have comorbid conditions, such as coronary artery disease, hyperlipidemia, and others. The two main anesthetic approaches are general anesthesia, including an endotracheal tube, with neurological monitoring and regional anesthesia that allows for an awake patient to be assessed neurologically. The objective of our study was to evaluate a novel anesthetic technique that combined general anesthesia with a laryngeal mask airway (LMA) plus regional anesthesia in the form of bupivacaine injected into the surgical site. Anesthesia was maintained with desflurane 4%, so the patient emerged rapidly for neurological assessment at the conclusion of surgery. We report on a case of a 55-year-old patient who underwent a successful carotid endarterectomy using this hybrid technique of general anesthesia with LMA plus regional anesthesia. This technique was safe and effective and the patient experienced no complications other than a hematoma on the left neck that was likely the result of long-term use of aspirin and Plavix. While further study is warranted, this hybrid technique of general anesthesia with LMA plus regional anesthesia holds promise for carotid endarterectomy patients.

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