TORONTO — New research evaluated the effect of cumulative exposure to anesthesia on neurocognitive outcomes among a multicenter cohort of children with acute lymphocytic leukemia (ALL).
“Many children treated for ALL develop long-term neurocognitive impairments. Increased risk of these impairments is associated with treatment and demographic factors,” according to the study led by researchers from The Hospital for Sick Children in Toronto and including participation from the7Uniformed Services University in Bethesda, MD. “Exposure to anesthesia is an additional possible risk factor.”
The study was part of AALL1131, a Children’s Oncology Group phase III trial for patients with high-risk B-ALL. In consenting patients aged 6–12 years, researchers performed prospective uniform assessments of neurocognitive function during and at 1 year after completion of therapy. Exposure to all episodes of anesthetic agents was abstracted.
The researchers included 144 children, 52.8% boys, with a mean age of 9.1 at diagnosis. The children had undergone a median of 27 anesthetic episodes (min-max, 1-37). Almost all patients were exposed to propofol (140/144, 97.2%), with a mean cumulative dose of 112.3 mg/kg.
“One year after therapy, the proportion of children with impairment (Z-score ≤-1.5) was significantly higher compared with a normative sample,” the authors pointed out in the Journal of Clinical Oncology. “In covariate-adjusted multivariable analysis, cumulative exposure to propofol was associated with a 0.05 Z-score decrease in reaction time/processing speed per each 10 mg/kg propofol exposure (P = .03).”1
The study concluded that, in a multicenter and uniformly treated cohort of children with B-ALL, cumulative exposure to propofol was an independent risk factor for impairment in reaction time/processing speed 1 year after therapy.
“Anesthesia exposure is a modifiable risk, and opportunities to minimize propofol use should be considered,” the authors recommended.
- Alexander S, Kairalla JA, Gupta S, Hibbitts E, et. Al.. Impact of Propofol Exposure on Neurocognitive Outcomes in Children With High-Risk B ALL: A Children’s Oncology Group Study. J Clin Oncol. 2024 Apr 11:JCO2301989. doi: 10.1200/JCO.23.01989. Epub ahead of print. PMID: 38603641.
