Anesthesia Exposure and Neurocognitive and Neuroimaging Outcomes in Long-Term Survivors of Childhood ALL


Key Points

  • Neurocognitive impairment was associated with higher propofol cumulative dose, flurane exposure, and longer anesthesia duration.
  • Slower processing speed was associated with higher propofol dose, greater number of exposures to fluranes, and longer anesthesia duration.

In a study reported in JAMA Oncology, Banerjee et al found that higher cumulative anesthesia exposure and duration of exposure during treatment of childhood acute lymphoblastic leukemia (ALL) may be associated with adverse neurocognitive and abnormal neuroimaging outcomes in long-term survivors.

The study involved data from 212 survivors of childhood ALL who received treatment between July 2000 and November 2010 at St. Jude Children’s Research Hospital and had both neurocognitive and brain imaging analyses. Neurocognitive measures of attention, processing speed, executive function, and intelligence were examined. Brain volumes, cortical thickness, and diffusion tensor imaging of the whole brain, corpus callosum, frontal lobes, and parietal lobes were assessed.

Key Findings

Mean age at diagnosis was 14.4 years, and mean follow-up was 7.7 years. In analysis adjusting for chemotherapy doses and age at diagnosis, neurocognitive impairment was associated with higher propofol cumulative dose (relative risk [RR] = 1.40 per 100 mg/kg, 95% confidence interval [CI] = 1.11–1.75), increased flurane exposure (RR = 1.10 per exposure, 95% CI = 1.01–1.21), and longer anesthesia duration (RR = 1.03 per cumulative hour, 95% CI = 1.00–1.06).

Slower processing speed was associated with higher propofol dose (P = .04), greater number of exposures to fluranes (P = .01), and longer anesthesia duration (P = .003). Greater corpus callosum white matter diffusivity was associated with dose of propofol (P = .01) and duration of anesthesia (P = .02). Processing speed was significantly correlated with corpus callosum diffusivity (r = −0.26, P < .001).

The investigators concluded, “Higher cumulative anesthesia exposure and duration may be associated with neurocognitive impairment and neuroimaging abnormalities in long-term survivors of childhood ALL, beyond the known outcomes associated with neurotoxic chemotherapies. Anesthesia exposures should be limited in pediatric populations with chronic health conditions who undergo multiple medical procedures.”

Kevin R. Krull, PhD, of the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, is the corresponding author for the JAMA Oncology article.

Disclosure: The study was supported by the National Institute of Mental Health, National Cancer Institute, and American Lebanese Syrian Associated Charities. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.