Evaluación de la asociación entre la exposición a anestesia general en niños menores de cinco años y alteraciones del neurodesarrollo. Revisión sistemática
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Ospina Serrano, Alejandro
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Introducción: En la última década, a través de estudios observacionales, se ha intentado establecer una asociación entre exposición a la anestesia general a temprana edad con alteraciones del neurodesarrollo en edades posteriores. Métodos: Hemos realizado una revisión sistemática para establecer la asociación entre la exposición a AG en niños menores de cinco años y alteraciones del neurodesarrollo, la búsqueda la realizamos a partir de bases de datos como Medline y EMBASE. Los desenlaces a evaluar fueron trastorno de hiperactividad y déficit de atención, desórdenes del espectro autista, retraso global del desarrollo y discapacidad del aprendizaje. Se incluyeron tanto estudios prospectivos controlados y aleatorizados, como estudios observacionales. Resultados: Los resultados fueron expuestos a través de síntesis narrativa, la mayoría de estudios evaluaron la exposición a la AG antes de los 3 años, se observó un mayor impacto de dicha exposición, sobre algunos dominios específicos del neurodesarrollo; no se encontró asociación entre exposición a AG con menor desempeño académico. Al parecer las exposiciones múltiples a la AG puede aumentar el riesgo de desarrollar déficit en algunos campos del aprendizaje, como también el desarrollo de desórden de hiperactividad y déficit de atención. Conclusiones: Existe posible asociación entre exposición a AG antes de los cinco años, con algunos dominios del neurodesarrollo, como lo es la cognición y el lenguaje; y la exposición múltiple puede aumentar el riesgo de desarrollar alteraciones del neurodesarrollo. Se necesitan estudios prospectivos que nos permitan establecer la relación causal entre exposición a AG y alteraciones del neurodesarrollo.
Abstract. Introduction: In the last decade, through observational studies, an attempt has been made to establish an association between exposure to general anesthesia at an early age with neurodevelopmental alterations at later ages. Methods: We performed a systematic review to establish the association between exposure to GA in children under five years and neurodevelopmental disorders, the search was done from databases such as Medline and EMBASE. The outcomes to be assessed were attention deficit hyperactivity disorder, autism spectrum disorders, overall developmental delay and learning disability. We included both prospective controlled and randomized studies, as well as observational cohort studies. Results: The results were exposed through narrative synthesis, most studies evaluated the exposure to GA before age 3, a greater impact of such exposure was observed, on some specific domains of neurodevelopment; No association was found between AG exposure and poor academic performance. It appears that multiple exposures to GA may increase the risk of developing deficits in some fields of learning, as well as the development of hyperactivity disorder and attention deficit disorder. Conclusions: There is a possible association between AG exposure before the age of five, with some domains of neurodevelopment, such as cognition and language; and multiple exposure may increase the risk of developing neurodevelopmental disorders. We need prospective studies that allow us to establish the causal relationship between exposure to GA and alterations of neurodevelopment.
Abstract. Introduction: In the last decade, through observational studies, an attempt has been made to establish an association between exposure to general anesthesia at an early age with neurodevelopmental alterations at later ages. Methods: We performed a systematic review to establish the association between exposure to GA in children under five years and neurodevelopmental disorders, the search was done from databases such as Medline and EMBASE. The outcomes to be assessed were attention deficit hyperactivity disorder, autism spectrum disorders, overall developmental delay and learning disability. We included both prospective controlled and randomized studies, as well as observational cohort studies. Results: The results were exposed through narrative synthesis, most studies evaluated the exposure to GA before age 3, a greater impact of such exposure was observed, on some specific domains of neurodevelopment; No association was found between AG exposure and poor academic performance. It appears that multiple exposures to GA may increase the risk of developing deficits in some fields of learning, as well as the development of hyperactivity disorder and attention deficit disorder. Conclusions: There is a possible association between AG exposure before the age of five, with some domains of neurodevelopment, such as cognition and language; and multiple exposure may increase the risk of developing neurodevelopmental disorders. We need prospective studies that allow us to establish the causal relationship between exposure to GA and alterations of neurodevelopment.