• Caleb H Ing, Charles J DiMaggio, Andrew J O Whitehouse, Mary K Hegarty, Ming Sun, Britta S von Ungern-Sternberg, Andrew J Davidson, Melanie M Wall, Guohua Li, and Lena S Sun.
• Departments of *Anesthesiology ††Anesthesiology and Pediatrics, Columbia University College of Physicians and Surgeons Departments of †Anesthesiology and Epidemiology ∥Anesthesiology and Biostatistics **Psychiatry and Biostatistics, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY ‡Telethon Kids Institute ¶School of Medicine and Pharmacology, The University of Western Australia §Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA #Department of Anaesthesia, Murdoch Childrens Research Institute & Royal Children's Hospital, Melbourne, Vic., Australia.
• J Neurosurg Anesthesiol. 2014 Oct 1;26(4):377-86.

IntroductionEpidemiologic studies examining the association between anesthetic exposure and neurodevelopmental outcomes have primarily focused on exposures occurring under 3 years of age. In this study, we assess outcomes associated with initial anesthetic exposure occurring between 3 and 10 years of age.MethodsWe used data from the Western Australian Pregnancy Cohort (Raine) Study to examine the risk of cognitive deficit at age 10 in children with initial anesthetic exposure between 3 and 5 years and between 5 and 10 years of age compared with children unexposed at those ages. The cohort included 2868 children born from 1989 to 1992 evaluated using a range of neuropsychological tests. A modified multivariable Poisson regression model was used to determine the adjusted association of initial anesthetic exposure in each age group with outcomes.ResultsExposed and unexposed children were found to have similar neuropsychological test results except for the McCarron Assessment of Neuromuscular Development (MAND) motor function scores. Even after adjusting for demographic and comorbidity differences, children exposed to anesthesia had a higher risk of motor deficit after initial exposure between ages 3 and 5 years (adjusted risk ratio, 2.32; 95% confidence interval, 1.42-3.79) and between 5 and 10 years (adjusted risk ratio, 2.33; 95% confidence interval, 1.21-4.48) compared with unexposed children.ConclusionsInitial exposure to anesthesia after age 3 had no measurable effects on language or cognitive function. Decreased motor function was found in children initially exposed after age 3 even after accounting for comorbid illness and injury history. These results suggest that there may be distinct windows of vulnerability for different neurodevelopmental domains in children.

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