TY - JOUR
T1 - Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome
AU - Diaz, Laura K.
AU - Gaynor, J. William
AU - Koh, Shannon J.
AU - Ittenbach, Richard F.
AU - Gerdes, Marsha
AU - Bernbaum, Judy C.
AU - Zackai, Elaine H.
AU - Clancy, Robert R.
AU - Rehman, Mohamed A.
AU - Pennington, Jeffrey W.
AU - Burnham, Nancy
AU - Spray, Thomas L.
AU - Nicolson, Susan C.
N1 - Funding Information:
This research was supported by a grant from the Fannie E. Rippel Foundation; American Heart Association National Grant-in-Aid (9950480N); Grant HL071834 from the National Institutes of Health; support from The Cardiac Center at The Children's Hospital of Philadelphia, the Alice Langdon Warner Endowed Chair in Pediatric Cardiothoracic Surgery and the Daniel M. Tabas Endowed Chair in Pediatric Cardiothoracic Surgery at The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania.
Publisher Copyright:
© 2016 The American Association for Thoracic Surgery
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Objectives Despite improved survival in children with hypoplastic left heart syndrome (HLHS), significant concern persists regarding their neurodevelopmental (ND) outcomes. Previous studies have identified patient factors, such as prematurity and genetic syndromes, to be associated with worse ND outcomes. However, no consistent relationships have been identified among modifiable management factors, including cardiopulmonary bypass strategies, and ND outcomes after cardiac surgery in infancy. Studies in immature animals, including primates, have demonstrated neurodegeneration and apoptosis in the brain after certain levels and extended durations of anesthetic exposure. Retrospective human studies have also suggested relationships between adverse ND effects and anesthetic exposure. Methods Cumulative minimum alveolar concentration hours (MAC-hrs) of exposure to volatile anesthetic agents (VAA) (desflurane, halothane, isoflurane, and sevoflurane) were collected from an anesthetic database and medical record review for 96 patients with HLHS or variants. ND testing was performed between ages 4 and 5 years, including full-scale IQ, verbal IQ, performance IQ, and processing speed. Four generalized linear modes were hypothesized a priori and tested using a Gaussian (normal) distribution with an identity link. Results Cumulative VAA exposure ranged from 0 to 35.3 MAC-hrs (median 7.5 hours). Using specified covariates identified previously as significant predictors of ND outcomes, statistically significant relationships were identified between total MAC-hrs exposure and worse full-scale IQ and verbal IQ scores (P's < .05) alone and after adjusting for relevant covariates. Conclusions Increased cumulative MAC-hrs exposure to VAA is associated with worse ND outcomes in certain domains in children with HLHS and variants.
AB - Objectives Despite improved survival in children with hypoplastic left heart syndrome (HLHS), significant concern persists regarding their neurodevelopmental (ND) outcomes. Previous studies have identified patient factors, such as prematurity and genetic syndromes, to be associated with worse ND outcomes. However, no consistent relationships have been identified among modifiable management factors, including cardiopulmonary bypass strategies, and ND outcomes after cardiac surgery in infancy. Studies in immature animals, including primates, have demonstrated neurodegeneration and apoptosis in the brain after certain levels and extended durations of anesthetic exposure. Retrospective human studies have also suggested relationships between adverse ND effects and anesthetic exposure. Methods Cumulative minimum alveolar concentration hours (MAC-hrs) of exposure to volatile anesthetic agents (VAA) (desflurane, halothane, isoflurane, and sevoflurane) were collected from an anesthetic database and medical record review for 96 patients with HLHS or variants. ND testing was performed between ages 4 and 5 years, including full-scale IQ, verbal IQ, performance IQ, and processing speed. Four generalized linear modes were hypothesized a priori and tested using a Gaussian (normal) distribution with an identity link. Results Cumulative VAA exposure ranged from 0 to 35.3 MAC-hrs (median 7.5 hours). Using specified covariates identified previously as significant predictors of ND outcomes, statistically significant relationships were identified between total MAC-hrs exposure and worse full-scale IQ and verbal IQ scores (P's < .05) alone and after adjusting for relevant covariates. Conclusions Increased cumulative MAC-hrs exposure to VAA is associated with worse ND outcomes in certain domains in children with HLHS and variants.
KW - anesthesia
KW - congenital heart surgery
KW - neurodevelopment
KW - neurotoxicity
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U2 - 10.1016/j.jtcvs.2016.03.095
DO - 10.1016/j.jtcvs.2016.03.095
M3 - Article
C2 - 27183886
AN - SCOPUS:84966708505
SN - 0022-5223
VL - 152
SP - 482
EP - 489
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -