BACKGROUND The GAS trial demonstrated evidence that most neurodevelopmental outcomes at 2 years and 5 years of age in infants who received a single general anaesthetic (GA) for elective inguinal herniorrhaphy were clinically equivalent when compared to infants who did not receive GA. More than 20% of the children in the trial had at least one subsequent anaesthetic exposure after their initial surgery. Using the GAS database, this study aimed to address whether multiple (2 or more) GA exposures compared to one or no GA exposure in early childhood were associated with worse neurodevelopmental outcomes at 5 years. METHODS Children with multiple GA exposures and children with one or no GA exposure were identified from the GAS database. The primary outcome was the full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence third edition (WPPSI-III) at 5 years of age. Secondary outcomes included neurocognitive tests addressing all major developmental domains and caregiver-reported questionnaires assessing emotional and behavioural problems. RESULTS Complete assessment was available from a total of 90 children in the multiple GA group and 141 children in the 0 or 1 GA group. Compared with children with a single or no GA exposure, multiply exposed children scored on average almost 6 points lower (mean: -5.8, 95% CI: -10.2 to -1.4, p= 0.011) in WPPSI-III FSIQ. They also demonstrated lower verbal and performance IQ scores and more emotional, behavioural, and executive function difficulties. However, significant residual confounding cannot be excluded from the results due to the observational nature of this study. CONCLUSIONS Multiple GA exposure before 5 years of age was associated with reduced performance in general intelligence score and some domains of neurodevelopmental assessments. The clinical significance of our results must be cautiously interpreted in light of several sources of limitations including small sample size and unadjusted residual confounding. This study illustrates the limitations of trial data sets that may not be fit for the purpose for the secondary analysis.

中文翻译：

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五岁前多次全身麻醉后的神经发育结果 - 一项队列研究。


背景 GAS 试验证明，与未接受 GA 的婴儿相比，接受单次全身麻醉 （GA） 治疗择期腹股沟疝修补术的婴儿在 2 岁和 5 岁时的大多数神经发育结局在临床上是等效的。试验中超过 20% 的儿童在初次手术后至少有一次后续麻醉暴露。使用 GAS 数据库，本研究旨在解决与儿童早期一次或没有 GA 暴露相比，多次（2 次或更多）GA 暴露是否与 5 岁时较差的神经发育结果相关。方法 从 GAS 数据库中确定了多次 GA 暴露的儿童和一次或没有 GA 暴露的儿童。主要结局是 5 岁时韦氏学龄前和初级智力量表第三版 （WPPSI-III） 的全面智商 （FSIQ）。次要结局包括针对所有主要发育领域的神经认知测试和照顾者报告的评估情绪和行为问题的问卷。结果 多重 GA 组共有 90 名儿童和 0 或 1 GA 组 141 名儿童进行了完整评估。与单次或没有 GA 暴露的儿童相比，多次暴露儿童在 WPPSI-III FSIQ 中的得分平均低近 6 分（平均值：-5.8,95% CI：-10.2 至 -1.4，p= 0.011）。他们还表现出较低的语言和表现智商分数，以及更多的情绪、行为和执行功能困难。然而，由于本研究的观察性质，不能从结果中排除显着的残余混杂因素。 结论 5 岁前多次 GA 暴露与一般智力评分和神经发育评估某些领域的表现降低相关。必须根据几个限制来源谨慎解释我们结果的临床意义，包括样本量小和未调整的残差混杂。本研究说明了可能不适合二次分析目的的试验数据集的局限性。