Infants and toddlers who are exposed to general anesthesia may be at increased risk for bipolar disorder later in childhood compared with infants and toddlers who are not exposed, according to a report in Schizophrenia Bulletin. The association remained after adjusting for other childhood comorbidities and parental psychiatric diagnoses.
“In the context of pediatric care, it is essential to recognize the substantial perioperative trauma experienced by children, both physically and psychologically,” wrote Mingyang Sun, M.D., of the People’s Hospital of Zhenghzou University in Henan, China, and colleagues. “Emerging evidence underscores the significant impact of early-life exposure to multiple anesthetics on neurodevelopment.”
The researchers compared the incidence of pediatric bipolar disorder in 7,535 children in Taiwan who were exposed to general anesthesia at age 3 or younger between 2004 and 2014 with that of an equal number of children who were not exposed. Data were drawn from the Taiwan Maternal and Child Health Database. The two groups of children were matched for other variables associated with bipolar risk, including premature birth, head injury, sexual abuse, malnutrition, toxic exposure, congenital abnormalities, and parental psychiatric illness.
A total of 223 (3%) of the children who were exposed to general anesthesia were diagnosed with bipolar disorder before age 12 compared with 178 (2.4%) of those who were not exposed. Children exposed to general anesthesia were 1.26 times more likely to develop bipolar disorder before age 12.
Sun and colleagues noted that general anesthesia’s potential to increase the risk of developing bipolar disorder involves intricate mechanisms, including neurotoxicity associated with specific anesthetic agents and disruptions in neural pathways. Sevoflurane, a commonly employed inhalation anesthetic, has garnered particular attention due to its neurotoxic effects, they wrote, but adding, “our study didn’t examine specific anesthetic agents’ effects on [bipolar disorder] development, an area ripe for future research to inform precise anesthesia choices and mitigate [bipolar disorder] risk in children.”
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