Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome

Laura K. Diaz, J. William Gaynor, Shannon J. Koh, Richard F. Ittenbach, Marsha Gerdes, Judy C. Bernbaum, Elaine H. Zackai, Robert R. Clancy, Mohamed A. Rehman, Jeffrey W. Pennington, Nancy Burnham, Thomas L. Spray, Susan C. Nicolson

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)482-489
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume152
Issue number2
DOIs
StatePublished - Aug 1 2016

Keywords

  • anesthesia
  • congenital heart surgery
  • neurodevelopment
  • neurotoxicity

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Diaz, L. K., Gaynor, J. W., Koh, S. J., Ittenbach, R. F., Gerdes, M., Bernbaum, J. C., Zackai, E. H., Clancy, R. R., Rehman, M. A., Pennington, J. W., Burnham, N., Spray, T. L., & Nicolson, S. C. (2016). Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome. Journal of Thoracic and Cardiovascular Surgery, 152(2), 482-489. https://doi.org/10.1016/j.jtcvs.2016.03.095