PMID- 36108191
OWN - NLM
STAT- MEDLINE
DCOM- 20220919
LR  - 20230522
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
VI  - 135
IP  - 4
DP  - 2022 Oct 1
TI  - Intraoperative Blood Pressure and Long-Term Neurodevelopmental Function in 
      Children Undergoing Ambulatory Surgery.
PG  - 787-797
LID - 10.1213/ANE.0000000000005853 [doi]
AB  - BACKGROUND: Some studies have found surgery and anesthesia in children to be 
      associated with neurodevelopmental deficits, but specific reasons for this 
      association have not been fully explored. This study evaluates intraoperative 
      mean arterial pressure (MAP) during a single ambulatory procedure in children and 
      subsequent mental disorder diagnoses. METHODS: A retrospective observational 
      study was performed including children >/=28 days and <18 years of age with 
      intraoperative electronic anesthetic records between January 1, 2009, and April 
      30, 2017, at our institution. Eligible children were categorized based on their 
      mean intraoperative MAP relative to other children of the same sex and similar 
      age: category 1 (very low): children with mean intraoperative MAP values below 
      the 10th percentile, category 2 (low): mean MAP value >/=10th and <25th 
      percentiles, category 3 (reference): mean MAP value >/=25th and <75th percentiles, 
      category 4 (high): mean MAP value >/=75th and <90th percentile, and category 5 
      (very high): mean MAP value >/=90th percentile. International Classification of 
      Diseases, Ninth Revision, Clinical Modification (ICD-9) and ICD, Tenth Revision, 
      Clinical Modification (ICD-10)-coded mental disorders were identified in hospital 
      and outpatient claims, with a median duration of follow-up after surgery of 120 
      days (interquartile range [IQR], 8-774.5 days). Cox proportional hazards models 
      evaluated the hazard ratio (HR) of time to first mental disorder diagnosis 
      associated with intraoperative blood pressure category between the end of surgery 
      and censoring, with the primary analysis adjusting for demographic, anesthetic, 
      comorbidity, and procedure-type variables as potential confounders. RESULTS: A 
      total of 14,724 eligible children who received general anesthesia for a single 
      ambulatory surgical procedure were identified. After adjusting for all available 
      potential confounders, when compared to the reference, there were no 
      statistically significant differences in mental disorder diagnosis risk based on 
      intraoperative mean MAP category. Compared to reference, children in the very low 
      and low blood pressure categories reported HRs of 1.00 (95% confidence interval 
      [CI], 0.74-1.35) and 1.10 (95% CI, 0.87-1.41) for a mental disorder diagnosis, 
      respectively, and children in the high and very high categories reported HRs of 
      0.87 (95% CI, 0.68-1.12) and 0.76 (95% CI, 0.57-1.03), respectively. CONCLUSIONS: 
      Presence in a predefined mean intraoperative MAP category was not associated with 
      subsequent mental disorder diagnoses within our follow-up period. However, the 
      limitations of this study, including uncertainty regarding what constitutes an 
      adequate blood pressure in children, may limit the ability to form definitive 
      conclusions.
CI  - Copyright (c) 2022 International Anesthesia Research Society.
FAU - Ing, Caleb
AU  - Ing C
AD  - From the Department of Anesthesiology, Columbia University Vagelos College of 
      Physicians and Surgeons, New York, New York.
AD  - Mailman School of Public Health, New York, New York.
FAU - DeStephano, David
AU  - DeStephano D
AD  - From the Department of Anesthesiology, Columbia University Vagelos College of 
      Physicians and Surgeons, New York, New York.
FAU - Hu, Tianheng
AU  - Hu T
AD  - Department of Biostatistics, Mailman School of Public Health, New York, New York.
FAU - Reighard, Charles
AU  - Reighard C
AD  - From the Department of Anesthesiology, Columbia University Vagelos College of 
      Physicians and Surgeons, New York, New York.
FAU - Lackraj, Deven
AU  - Lackraj D
AD  - From the Department of Anesthesiology, Columbia University Vagelos College of 
      Physicians and Surgeons, New York, New York.
FAU - Geneslaw, Andrew S
AU  - Geneslaw AS
AD  - Department of Pediatrics, Columbia University Vagelos College of Physicians and 
      Surgeons, New York, New York.
FAU - Miles, Caleb H
AU  - Miles CH
AD  - Department of Biostatistics, Mailman School of Public Health, New York, New York.
FAU - Kim, Minjae
AU  - Kim M
AD  - From the Department of Anesthesiology, Columbia University Vagelos College of 
      Physicians and Surgeons, New York, New York.
AD  - Mailman School of Public Health, New York, New York.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20220915
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
RN  - 0 (Anesthetics)
SB  - IM
CIN - Anesth Analg. 2023 Jun 1;136(6):e32-e33. PMID: 37205815
MH  - *Ambulatory Surgical Procedures/adverse effects
MH  - Anesthesia, General
MH  - *Anesthetics
MH  - Arterial Pressure
MH  - Blood Pressure
MH  - Child
MH  - Humans
COIS- The authors declare no conflicts of interest.
EDAT- 2022/09/16 06:00
MHDA- 2022/09/20 06:00
CRDT- 2022/09/15 15:22
PHST- 2022/09/15 15:22 [entrez]
PHST- 2022/09/16 06:00 [pubmed]
PHST- 2022/09/20 06:00 [medline]
AID - 00000539-202210000-00021 [pii]
AID - 10.1213/ANE.0000000000005853 [doi]
PST - ppublish
SO  - Anesth Analg. 2022 Oct 1;135(4):787-797. doi: 10.1213/ANE.0000000000005853. Epub 
      2022 Sep 15.