Pediatric anesthesia and neurodevelopmental impairments: a Bayesian meta-analysis.
Experimental evidence of anesthesia-induced neurotoxicity has caused serious concern about the long-term effect of commonly used volatile anesthetic agents on young children. Several observational studies based on existing data have been conducted to address this concern with inconsistent results. We conducted a meta-analysis to synthesize the epidemiologic evidence on the association of anesthesia/surgery with neurodevelopmental outcomes in children. Using Bayesian meta-analytic approaches, we estimated the synthesized odds ratios (OR) and 95% credible interval (CrI) as well as the predictive distribution of a future study given the synthesized evidence. Data on 7 unadjusted and 6 adjusted measures of association were abstracted from 7 studies. The synthesized OR based on the 7 unadjusted measures for the association of anesthesia/surgery with an adverse behavioral or developmental outcome was 1.9 (95% CrI, 1.2-3.0). The most likely unadjusted OR from a future study was estimated to be 2.2 (95% CrI, 0.6-6.1). The synthesized OR based on the 6 adjusted measures for the association of anesthesia/surgery with an adverse behavioral or developmental outcome was 1.4 (95% CrI, 0.9-2.2). The most likely adjusted OR from a future study was estimated to be 1.5 (95% CrI, 0.5-4.0). We conclude that existent epidemiologic evidence suggests a modestly elevated risk of adverse behavioral or developmental outcomes in children who were exposed to anesthesia/surgery during early childhood. The evidence, however, is considerably uncertain.
Department of Anesthesiology, Columbia University, New York, NY 10032, USA. cjd11@columbia.edu
Charles
C
DiMaggio
Lena S
LS
Sun
Caleb
C
Ing
Guohua
G
Li
D000758:Anesthesia / Q000009:adverse effects*; D001499:Bayes Theorem; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009010:Monte Carlo Method; D009420:Nervous System / Q000254:growth & development*; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000453:epidemiology; D018401:Sample Size; D012984:Software