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Cognitive Outcome After Spinal Anesthesia and Surgery During Infancy

Williams, Robert K. MD*; Black, Ian H. MD; Howard, Diantha B. MS; Adams, David C. MD; Mathews, Donald M. MD; Friend, Alexander F. MS; Meyers, H. W. Bud PhD§

doi: 10.1213/ANE.0000000000000288
Pediatric Neuroscience: Research Report

BACKGROUND: Observational studies on pediatric anesthesia neurotoxicity have been unable to distinguish long-term effects of general anesthesia (GA) from factors associated with the need for surgery. A recent study on elementary school children who had received a single GA during the first year of life demonstrated an association in otherwise healthy children between the duration of anesthesia and diminished test scores and also revealed a subgroup of children with “very poor academic achievement” (VPAA), scoring below the fifth percentile on standardized testing. Analysis of postoperative cognitive function in a similar cohort of children anesthetized with an alternative to GA may help to begin to separate the effects of anesthesia from other confounders.

METHODS: We used a novel methodology to construct a combined medical and educational database to search for these effects in a similar cohort of children receiving spinal anesthesia (SA) for the same procedures. We compared former patients with a control population of students matched by grade, gender, year of testing, and socioeconomic status.

RESULTS: Vermont Department of Education records were analyzed for 265 students who had a single exposure to SA during infancy for circumcision, pyloromyotomy, or inguinal hernia repair. Exposure to SA and surgery had no significant effect on the odds of children having VPAA. (mathematics: P = 0.18; odds ratio 1.50, confidence interval (CI), 0.83–2.68; reading: P = 0.55; odds ratio = 1.19, CI, 0.67–2.1). There was no relationship between duration of exposure to SA and surgery and performance on mathematics (P = 0.73) or reading (P = 0.57) standardized testing. There was a small but statistically significant decrease in reading and math scores in the exposed group (mathematics: P = 0.03; reading: P = 0.02).

CONCLUSIONS: We found no link between duration of surgery with infant SA and scores on academic achievement testing in elementary school. We also found no relationship between infant SA and surgery with VPAA on elementary school testing, although the CIs were wide.

Published ahead of print June 10, 2014.

From the *Department of Anesthesiology, Vermont Children’s Hospital; †Department of Anesthesiology, Fletcher Allen Health Care; ‡Center for Clinical and Translational Science, University of Vermont; and §James M. Jeffords Center for Policy Research, University of Vermont, Burlington, Vermont.

Published ahead of print June 10, 2014.

Accepted for publication March 22, 2014.

Funding: Departmental Funding.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the 2013 International Anesthesia Research Society Annual Meeting.

Reprints will not be available from the authors.

Address correspondence to Robert K. Williams, MD, Department of Anesthesia, Vermont Childrens Hospital, University of Vermont, Fletcher Allen Health Care Colchester Ave., Burlington, VT 05401. Address e-mail to

© 2014 International Anesthesia Research Society