Anesthesia for Cesarean Delivery and Learning Disabilities in a Population-based Birth Cohort

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
Anesthesiology (Impact Factor: 5.88). 09/2009; 111(2):302-10. DOI: 10.1097/ALN.0b013e3181adf481
Source: PubMed


Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort.
The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia).
Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia n = 193, and regional anesthesia n = 304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia before age 4 yr, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P = 0.017 for comparison of CD under regional anesthesia compared to vaginal delivery).
Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.

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Available from: Juraj Sprung, Jan 22, 2014
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    • "The authors suggested that dyslexia could be related to a disconnection syndrome, signaling candidate genes (DCDC2, KIAA0319, DYX1C1) associated with neuroanatomical alterations, involving both the white and the gray matter of a fronto-temporo-parietal network, suggestive of dysfunction in cortical connectivity. Several acquired factors have been also involved such as: childbirth dystocias, neonatal asphyxia, neonatal icterus, cardiorespiratory arrest, status epilepticus, low birth weight and preterm birth [7-9], smoker mother during pregnancy [10], exposure to more than 2 general anesthesia within the fourth year of life [11,12], parental history of alcoholism or substance abuse [13] and prenatal exposure to cocaine [14]. School, family and social context are also interweave with neurobiological and contribute to determine the multifactorial nature of LD. "
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    ABSTRACT: Learning Disorders (LD) are complex diseases that affect about 2-10% of the school-age population. We performed neuropsychological and psychopathological evaluation, in order to investigate comorbidity in children with LD. Our sample consisted of 448 patients from 7 to 16 years of age with a diagnosis of LD, divided in two subgroups: Specific Learning Disorders (SLD), including reading, writing, mathematics disorders, and Learning Disorders Not Otherwise Specified (LD NOS). Comorbidity with neuropsychopathologies was found in 62.2% of the total sample. In the LSD subgroup, ADHD was present in 33%, Anxiety Disorder in 28.8%, Developmental Coordination Disorder in 17.8%, Language Disorder in 11% and Mood Disorder in 9.4% of patients. In LD NOS subgroup, Language Disorder was present in 28.6%, Developmental Coordination Disorder in 27.5%, ADHD in 25.4%, Anxiety Disorder in 16.4%, Mood Disorder in 2.1% of patients. A statistically significant presence was respectively found for Language and Developmental Coordination Disorder comorbidity in LD NOS and for ADHD, mood and anxiety disorder comorbidity in SLD subgroup. The different findings emerging in this study suggested to promote further investigations to better define the difference between SLD and LD NOS, in order to improve specific interventions to reduce the long range consequences.
    BMC Neurology 12/2013; 13(1):198. DOI:10.1186/1471-2377-13-198 · 2.04 Impact Factor
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    • "Those children receiving anesthesia before 3 years of age are more likely to have learning and behavior disorders compared with peers without anesthesia [7,13]. It seems that exposure to anesthesia in early life more than once or for a prolonged period adversely affects long-term neurodevelopmental outcomes in children [6,42]. This is consistent with studies in which neonatal animals (at the synaptogenesis period) exposed to anesthetics develop abnormal cognition and behavior. "
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    ABSTRACT: Compelling evidence has shown that exposure to anesthetics used in the clinic can cause neurodegeneration in the mammalian developing brain, but the basis of this is not clear. Neurotoxicity induced by exposure to anesthestics in early life involves neuroapoptosis and impairment of neurodevelopmental processes such as neurogenesis, synaptogenesis and immature glial development. These effects may subsequently contribute to behavior abnormalities in later life. In this paper, we reviewed the possible mechanisms of anesthetic-induced neurotoxicity based on new in vitro and in vivo findings. Also, we discussed ways to protect against anesthetic-induced neurotoxicity and their implications for exploring cellular and molecular mechanisms of neuroprotection. These findings help in improving our understanding of developmental neurotoxicology and in avoiding adverse neurological outcomes in anesthesia practice.
    International Journal of Molecular Sciences 12/2012; 13(6):6772-99. DOI:10.3390/ijms13066772 · 2.86 Impact Factor
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    • "Two studies showed that exposure to multiple surgeries under general anesthesia increased the risk of learning disabilities [88,89]. The other 6 studies including two studies on twins did not show a link of general anesthesia and surgery to the development of learning disabilities [90-95]. The studies using twins are particularly powerful in this setting because they compared the learning abilities between the discordant twins (one twin was exposed and the other was not exposed to general anesthesia and surgery) [94,95]. "
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    ABSTRACT: Volatile anesthetics are one class of the most commonly used drugs. However, the mechanisms for these drugs to induce anesthesia are not fully understood and have been under intensive investigation. Two other effects of these anesthetics on the central nervous system, volatile anesthetics-induced neuroprotection and neurotoxicity, currently are hot research fields. Although data from animal studies for these two effects are extensive and convincing, clinical data for volatile anesthetics-induced neuroprotection are relatively weak. There is essentially lack of evidence to suggest volatile anesthetics-induced neurotoxicity in humans. In this regard, the contribution of general anesthesia/anesthetics to postoperative cognitive decline, a clinical entity whose existence has been supported by substantial evidence, also has not been established. This paper will be focused on reviewing the evidence, especially the clinical evidence, for volatile anesthetics-induced neuroprotection and neurotoxicity. Efforts will be devoted to facilitating the understanding of the two seemingly contradictory effects of these important drugs on the brain.
    04/2012; 2(1):10. DOI:10.1186/2045-9912-2-10
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