title: Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia.
abstract: BACKGROUND
  Anesthetics induce widespread cell death, permanent neuronal deletion, and neurocognitive impairment in immature animals, raising substantial concerns about similar effects occurring in young children. Epidemiologic studies have been unable to sufficiently address this concern, in part due to reliance on group-administered achievement tests, inability to assess brain structure, and limited control for confounders.
  
  
  METHODS
  We compared healthy participants of a language development study at age 5 to 18 years who had undergone surgery with anesthesia before 4 years of age (n = 53) with unexposed peers (n = 53) who were matched for age, gender, handedness, and socioeconomic status. Neurocognitive assessments included the Oral and Written Language Scales and the Wechsler Intelligence Scales (WAIS) or WISC, as appropriate for age. Brain structural comparisons were conducted by using T1-weighted MRI scans.
  
  
  RESULTS
  Average test scores were within population norms, regardless of surgical history. However, compared with control subjects, previously exposed children scored significantly lower in listening comprehension and performance IQ. Exposure did not lead to gross elimination of gray matter in regions previously identified as vulnerable in animals. Decreased performance IQ and language comprehension, however, were associated with lower gray matter density in the occipital cortex and cerebellum.
  
  
  CONCLUSIONS
  The present findings suggest that general anesthesia for a surgical procedure in early childhood may be associated with long-term diminution of language abilities and cognition, as well as regional volumetric alterations in brain structure. Although causation remains unresolved, these findings nonetheless warrant additional research into the phenomenon's mechanism and mitigating strategies.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Barynia
authors.initials: B
authors.lastname: Backeljauw
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Holland
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Mekibib
authors.initials: M
authors.lastname: Altaye
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati College of Medicine, Cincinnati, Ohio pedsanesthesia@gmail.com.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Loepke
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000379:methods*; D001921:Brain / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007360:Intelligence / Q000502:physiology*; D007361:Intelligence Tests; D007804:Language Development; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications; D013997:Time Factors