RISS 검색 - 국내학술지논문 상세보기

다국어 초록 (Multilingual Abstract)

Background: There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children.
Methods: This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months.
Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date.
Results: The median age at the index date was 3.8 (95% confidence interval [CI], 1.7–5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5–17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30–1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ.
Conclusion: Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.

번역하기

참고문헌 (Reference)

1 Briner A, "Volatile anesthetics rapidly increase dendritic spine density in the rat medial prefrontal cortex during synaptogenesis" 112 (112): 546-556, 2010

2 Gruschow SM, "Validation of the use of electronic health records for classification of ADHD status" 23 (23): 1647-1655, 2016

3 Andersen SL, "Trajectories of brain development : point of vulnerability or window of opportunity?" 27 (27): 3-18, 2003

4 Grabowski J, "The effects of early anesthesia on neurodevelopment : a systematic review" 56 (56): 851-861, 2021

5 Clausen NG, "Systematic review of the neurocognitive outcomes used in studies of paediatric anaesthesia neurotoxicity" 120 (120): 1255-1273, 2018

6 Zhang LL, "Shift of intracellular chloride concentration in ganglion and amacrine cells of developing mouse retina" 95 (95): 2404-2416, 2006

7 Tsai CJ, "Risk of ADHD after multiple exposures to general anesthesia : a nationwide retrospective cohort study" 22 (22): 229-239, 2018

8 Walters JL, "Review of preclinical studies on pediatric general anesthesia-induced developmental neurotoxicity" 60 : 2-23, 2017

9 Warner DO, "Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia : the Mayo Anesthesia Safety in Kids(MASK)study" 129 (129): 89-105, 2018

10 McCann ME, "Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy(GAS) : an international, multicentre, randomised, controlled equivalence trial" 393 (393): 664-677, 2019