Are Anesthesia and Surgery during Infancy Associated with Decreased White Matter Integrity and Volume during Childhood?

Robert I. Block, Vincent A. Magnotta, Emine O. Bayman, James Y. Choi, Joss J. Thomas, Karolie K. Kimble

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Anesthetics have neurotoxic effects in neonatal animals. Relevant human evidence is limited. We sought such evidence in a structural neuroimaging study. Methods: Two groups of children underwent structural magnetic resonance imaging: patients who, during infancy, had one of four operations commonly performed in otherwise healthy children and comparable, nonexposed control subjects. Total and regional brain tissue composition and volume, as well as regional indicators of white matter integrity (fractional anisotropy and mean diffusivity), were analyzed. Results: Analyses included 17 patients, without potential confounding central nervous system problems or risk factors, who had general anesthesia and surgery during infancy and 17 control subjects (age ranges, 12.3 to 15.2 yr and 12.6 to 15.1 yr, respectively). Whole brain white matter volume, as a percentage of total intracranial volume, was lower for the exposed than the nonexposed group, 37.3 ± 0.4% and 38.9 ± 0.4% (least squares mean ± SE), respectively, a difference of 1.5 percentage points (95% CI, 0.3 to 2.8; P = 0.016). Corresponding decreases were statistically significant for parietal and occipital lobes, infratentorium, and brainstem separately. White matter integrity was lower for the exposed than the nonexposed group in superior cerebellar peduncle, cerebral peduncle, external capsule, cingulum (cingulate gyrus), and fornix (cres) and/or stria terminalis. The groups did not differ in total intracranial, gray matter, and cerebrospinal fluid volumes. Conclusions: Children who had anesthesia and surgery during infancy showed broadly distributed, decreased white matter integrity and volume. Although the findings may be related to anesthesia and surgery during infancy, other explanations are possible.

Original languageEnglish (US)
Pages (from-to)788-799
Number of pages12
Issue number5
StatePublished - Nov 1 2017

Bibliographical note

Funding Information:
The authors thank Peggy C. Nopoulos, M.D., Daniel S. O'Leary, Ph.D., and Jatin G. Vaidya, Ph.D., Department of Psychiatry, University of Iowa (Iowa City, Iowa); Daniel J. Bonthius, M.D., Ph.D., Department of Pediatrics, University of Iowa (Iowa City, Iowa); and Michael M. Todd, M.D., Department of Anesthesiology, University of Minnesota, (Minneapolis, Minnesota), for advice concerning study design, image analyses, and/or interpretation of results. Supported by SmartTots (San Francisco, California) and Department of Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa (Iowa City, Iowa).

Publisher Copyright:
© 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.


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