RISK OF ADHD DEVELOPMENT FOLLOWING MULTIPLE EXPOSURES TO GENERAL ANESTHESIA IN THE PEDIATRIC POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS
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Introduction: The risk of attention deficit hyperactivity disorder (ADHD) following multiple exposures to anesthesia has been debated in recent literature. Our study aims to settle the conflict among currently published literature. Methods: A systematic search of EMBASE, PubMed, SCOPUS, and clinicaltrials.gov was performed using the key search terms “anesthesia”, “general anesthesia”, “attention deficit disorder with hyperactivity”, and “attention deficit disorder”. Following two stages of screening effect estimates including hazard ratios (HR) and associated 95% confidence intervals (CI), percentage, and relative risk and associated 95% CI were extracted. Studies which did not report HR and 95% CI as their effect estimate were quantitatively analyzed separately. Studies which reported HR and 95% CI were pooled and a meta-analysis was performed. Hazard Ratio and 95% CI were calculated to determine if a relationship exists between multiple exposures to general anesthesia and ADHD diagnosis. Results: Eight studies addressing ADHD diagnosis following multiple exposures to anesthesia met inclusion criteria. Five of the included studies reported HR and 95% CI so were pooled for meta-analysis. Three studies did not report HR and 95% CI so were quantitatively analyzed separately. Multiple exposures to anesthesia were found to be associated with diagnosis of ADHD before the 19th year of life (HR = 1.74 [95% CI = 1.62-1.87]). Conclusion: This systematic review and meta-analysis demonstrates an association between multiple early exposures to general anesthesia and later diagnosis of ADHD.