Although there is reasonable confidence that a single general anaesthetic before three years of age has no consequences for intelligence development, there is an association between multiple exposures and learning and behavioural difficulties, possibly including ADHD. Animal studies have demonstrated ADHD-like changes in juvenile rats exposed to general anaesthetics.

There is a plausible physiological explanation for how general anaesthesia may induce ADHD, involving disruption of the prefrontal cortex and basal ganglia via dopaminergic, glutaminergic and neutrophic factor mechanisms.

Nonetheless, evidence to date linking general anaesthetic exposure in young children and ADHD development is far from conclusive and – as with many areas of practice – requires further research.

summary

• L Xu, Y Hu, L Huang, Y Liu, B Wang, L Xie, and Z Hu.
• Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
• Anaesthesia. 2019 Jan 1; 74 (1): 57-63.

AbstractAttention deficit hyperactivity disorder is a chronic neurodevelopmental disorder, manifesting primarily as attention deficit, hyperactivity and impulsive behaviour. General anaesthetics can be neurotoxic, affecting neuronal differentiation and synaptogenesis, which can lead to abnormalities of cognition, learning and behaviour. We hypothesise that exposure of the immature brain to general anaesthetics predisposes to the development of attention deficit hyperactivity disorder. In this review, we summarise clinical and animal studies that relate attention deficit hyperactivity disorder to general anaesthesia, by actions on neural molecular mechanisms and neural networks. We also describe potential therapeutic approaches to modulate these effects.© 2018 Association of Anaesthetists.

This article appears in the collection: Is anaesthesia-related neurotoxicity significant in young children?.

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