Early childhood general anaesthesia exposure and neurocognitive development
Early childhood general anaesthesia exposure and neurocognitive development
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DOI：
10.1093/bja/aeq302
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发表时间：
2010-12-01
影响因子：
9.8
通讯作者：
Sun, L.
中科院分区：
文献类型：
--
作者：
Sun, L.
最近，人们对婴儿和儿童麻醉的安全性产生了很大的关注。在啮齿动物和非人类灵长类动物中有越来越多的令人信服的临床前证据表明，临床常用的麻醉剂对体外发育中的大脑具有神经毒性，并在体内引起长期神经行为异常。据估计，仅在美国每年就有600万儿童（包括150万婴儿）接受手术和麻醉，因此麻醉神经毒性的临床相关性是公共卫生的紧迫问题。对婴儿和儿童麻醉剂的长期神经发育影响进行的临床研究是对现有数据的回顾性分析。目前正在进行两项大规模的临床研究，以进一步解决这一问题。PANDA研究是一项在美国开展的大规模、多中心、双向同胞配对队列研究。本研究的目的是检查暴露于全身麻醉期间腹股沟疝手术前36个月的年龄神经发育的影响。另一项大规模研究是GAS研究，该研究将在接受腹股沟疝修补术的婴儿中比较两种麻醉技术（全身七氟烷麻醉和区域麻醉）的神经发育结局。这些研究结果应提供与儿童麻醉神经毒性相关的重要信息。
A great deal of concern has recently arisen regarding the safety of anaesthesia in infants and children. There is mounting and convincing preclinical evidence in rodents and non-human primates that anaesthetics in common clinical use are neurotoxic to the developing brain in vitro and cause long-term neurobehavioural abnormalities in vivo. An estimated 6 million children (including 1.5 million infants) undergo surgery and anaesthesia each year in the USA alone, so the clinical relevance of anaesthetic neurotoxicity is an urgent matter of public health. Clinical studies that have been conducted on the long-term neurodevelopmental effects of anaesthetic agents in infants and children are retrospective analyses of existing data. Two large-scale clinical studies are currently underway to further address this issue. The PANDA study is a large-scale, multisite, ambi-directional sibling-matched cohort study in the USA. The aim of this study is to examine the neurodevelopmental effects of exposure to general anaesthesia during inguinal hernia surgery before 36 months of age. Another large-scale study is the GAS study, which will compare the neurodevelopmental outcome between two anaesthetic techniques, general sevoflurane anaesthesia and regional anaesthesia, in infants undergoing inguinal hernia repair. These study results should contribute significant information related to anaesthetic neurotoxicity in children.