Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis.
In this systematic review and meta-analysis, Ing et al have evaluated three papers (GAS, MASK, PANDA) to determine the effect of exposure to a single general anaesthetic on long term neurodevelopmental outcomes in children < 18 years old.
The outcome scores evaluated included parental scoring systems (CBCL total problems, CBCL externalising problems, CBCL internalising problems), BRIEF Global Executive Composite Score, and FSIQ (full-scale intelligence quotient). Children exposed to a single GA were at increased risk of their score exceeding a predetermined threshold.
This study provides a summary of the current literature to date to help address parental concerns around general anaesthesia. The small number of papers included in this metanalysis may not add more than the individual papers themselves. Although a statistically significant difference between BRIEF and CBCL scores was found, the score differences of only ~0.2 of a standard deviation may not have clinical significance on an individual basis. In addition, parent-reported outcome scores can be unreliable and may contribute to bias. The authors comment that the differences in score may be more pronounced in vulnerable children and thus our responsibility to consider the impact of general anaesthesia on these children.
Due to the small number of papers in the meta-analysis, one must have reservations in applying this information to our clinical practice. The heterogeneity of the studies and the effect of underlying confounders such as home environment and parental behaviours were not discussed. Notwithstanding, these may contribute to the definition of the vulnerable child mentioned in the study.
Reviewed by Dr. Aylin Seven