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The role of general anesthesia on traits of neurodevelopmental disorders in a Swedish cohort of twins.

Journal article
Authors Albert Castellheim
Sebastian Lundström
Mattias Molin
Ralf Kuja-Halkola
I Carina Gillberg
Christopher Gillberg
Published in Journal of child psychology and psychiatry, and allied disciplines
Volume 59
Issue 9
Pages 966-972
ISSN 1469-7610
Publication year 2018
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Gillberg Neuropsychiatry Centre
Centre for Ethics, Law, and Mental Health
Pages 966-972
Language en
Keywords ADHD; Neurodevelopmental disorders; congenital abnormalities; general anesthesia; system diseases
Subject categories Child and adolescent psychiatry


The role of general anesthetics as a risk factor for possible neurodevelopmental disorders (NDDs) in humans is unresolved. The investigation of the role of anesthetics in the development of postgeneral anesthesia (anesthesia onward) NDDs has proven to be complicated, partly because of the inherent confounding in clinical cohort studies, and partly by the fact that anesthetics are only one part in the complex process of anesthesia-surgery.Utilizing the Swedish databases Child and Adolescent Twins Study in Sweden (CATSS) and National Patient Register (NPR), we investigated twins discordant for anesthesia, born between 1997 and 2004 for traits of NDDs. We identified 68 twin pairs discordant for anesthesia and explored traits of Attention-Deficit/Hyperactivity Disorder (ADHD), Learning Disability (LD), and Autism Spectrum Disorder (ASD) in them while simultaneously taking congenital abnormalities and systemic disorders (CSDs) into account. We analyzed the possible effect of anesthesia on neurodevelopmental problems, and we analyzed the within-pair differences using conditional linear regression.Twins with a recorded episode of anesthesia had higher traits of NDDs than twins without; similarly twins with CSDs had higher mean scores on all traits than twins without CSDs. The within-pair analyses suggested that exposure to anesthesia was associated with higher scores of ADHD (regression coefficient 1.02 and 95% confidence intervals: 0.27-1.78) in monozygotic (MZ) twins discordant for anesthesia. This effect remained when adjusting for congenital abnormalities.Our finding that traits of ADHD were slightly associated with anesthesia in a genetically sensitive design is in need of replication and warrants further investigation. Future studies should aim to elucidate mechanisms behind this possible association (e.g. anesthetics doses, age at exposure, exposure duration).

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