Neurodevelopmental Outcome at 2 Years of Age After General Anaesthesia and Awake-Regional Anaesthesia in Infancy (GAS): an International Multicentre, Randomized Controlled Trial

Neurodevelopmental Outcome at 2 Years of Age After General Anaesthesia and Awake-Regional Anaesthesia in Infancy (GAS): an International Multicentre, Randomized Controlled Trial
Davidson, AJ, 2016, The Lancet (Link to abstract)

 

This paper reports the secondary outcome of an RCT comparing neurodevelopmental outcomes in infants undergoing surgery for inguinal hernias. The randomization is between general anaesthesia (sevofluorane) and regional awake anaesthesia. The outcome reported here is neurodevelopmental outcome at 2 years of age by the Bayley scale. 360 infants less than 60 weeks postmenstrual age (premature babies were included) were in each arm in the intention to treat analysis although 69 in the regional group were converted to general anaesthesia. There was no difference in the mean of the composite cognitive score between the groups. The analysis reported here was a per-protocol analysis (not intention to treat).


* This is a hot area of contention in all fields of paediatrics – how much harm are we doing to our young patients when we put them under GA? This RCT (the first to ask this question) suggests the harm may not be real. But bear in mind that these children underwent a single short procedure – not multiple GAs over the course of the year the way our patients do. The primary outcome is the Weschler intelligence scale at 5 years of age and will be reported in the future.