Anesthesia Exposure Negatively Associated With Neurocognitive Function in Survivors of ALL

Higher cumulative exposure and longer duration of anesthesia may be associated with reduced neurocognitive function and neuroimaging abnormalities in survivors of childhood acute lymphoblastic leukemia (ALL), according to a recent study (JAMA Onc. 2019 Jun 20. Epub ahead of print).

“Limited studies have reported associations between anesthesia and neurocognitive and neuroimaging outcomes, particularly in pediatric patients who undergo multiple exposures to anesthesia as part of chronic disease management,” explained Pia Banerjee, PhD, Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee, and colleagues.

Dr Banerjee and her co-investigators identified 301 survivors of childhood ALL who received treatment between July 7, 2000, and November 3, 2010. Of these patients, 217 (72.1%) agreed to participate in long-term follow-up. Data analysis was performed between August 23, 2017, and May 3, 2018.

Data on duration and cumulative doses of all anesthetics, sedative, analgesics, anxiolytics, and neuromuscular blockers were reviewed for 5699 anesthesia procedures, as well as cumulative doses of high-dose intravenous methotrexate and number of triple intrathecal chemotherapy treatments.

Dr Banerjee and colleagues examined neurocognitive measures, including attention, processing speed, executive function, and intelligence. Brain volumes, cortical thickness, and diffusion tensor imaging of the whole brain, corpus callosum, frontal lobes, and parietal lobes were also evaluated.

Of the 217 patients who agreed to participate, 212 were included in the neurocognitive and brain imaging analyses.

Adjusting for chemotherapy doses and age at diagnosis, neurocognitive impairment was associated with higher propofol cumulative dose (relative risk [RR], 1.40 per 100 mg/kg; 95% CI, 1.11-1.75), flurane exposure (RR, 1.10 per exposure; 95% CI, 1.01-1.21), and longer anesthesia duration (RR, 1.03 per cumulative hour; 95% CI, 1.00-1.06).

In addition, slower processing speed was associated with higher propofol dose (estimate [est], −0.30; P = .04), greater number of exposures to fluranes (est, −0.14; P = .01), and longer anesthesia duration (est, −0.04; P = .003). 

“Higher cumulative anesthesia exposure and duration may be associated with neurocognitive impairment and neuroimaging abnormalities in long-term survivors of childhood acute lymphoblastic leukemia, beyond the known outcomes associated with neurotoxic chemotherapies,” Dr Banerjee and colleagues concluded.

“Anesthesia exposures should be limited in pediatric populations with chronic health conditions who undergo multiple medical procedures,” they added.—Janelle Bradley