The effects of general anesthesia on cognition in children – a review

Abstract

The theoretical models of pathophysiological mechanisms responsible for cognitive sequelae after general anesthesia are multifactorial, as most general anesthetics impact several neurotransmitter systems of the nervous system. Animal models show, that during periods of maturation neurons are more susceptible to damage from general anesthetics, while mature neurons are largely unaffected. Research done in children is mostly based on retrospective studies and their results tend to show that general anesthesia mostly impairs cognitive abilities, that are functionally under intense development at the time (for example speech between the ages of 2 and 4) although current data does not allow for definite conclusions about cognitive functions being affected. Most reported cognitive deficits are subclinical but tend to be present across a wide range of cognitive functions. However, no effect of general anesthesia on general intelligence has been noted. Cognitive consequences after general anesthesia in children are diverse and can be intertwined with the underlying condition that led to the use of general anesthesia. Current clinical guidelines suggest general anesthesia in children should be used in the lowest and shortest effective dose. The consensus is that withholding necessary treatments under general anesthesia would bring more harm than exposure to general anesthesia, therefore in clinical practice attention must be given to potential cognitive deficits in children who underwent procedures under general anesthesia.

Keywords

• general anesthesia
• child development
• cognition
• children