General anesthetics and the developing brain
General anesthetics and the developing brain
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DOI：
10.1097/aco.0b013e3283294c9e
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发表时间：
2009-06-01
影响因子：
2.5
通讯作者：
Loepke, Andreas W.
中科院分区：
文献类型：
--
作者：
Istaphanous, George K.;Loepke, Andreas W.
综述目的全麻药和镇静剂每年用于数百万儿童，以促进手术室、放射科病房、急诊科和ICU的外科手术、影像研究和镇静。越来越多的动物研究证据表明，长期接触这些化合物可能会导致广泛的神经细胞死亡和神经系统后遗症，严重质疑儿科麻醉的安全性。这篇综述介绍了这个迅速崛起的领域的最新进展。最近的发现在动物身上，所有现有的麻醉剂和镇静剂，如氯胺酮、咪达唑仑、安定、氯硝西潘、异丙酚、戊巴比妥、水合氯醛、氟烷、异氟烷、七氟烷、安氟醚、一氧化二氮和氙气，都被证明会在未成熟的大脑中引发广泛的神经变性。在人类中，最近的流行病学研究的初步发现表明，手术和生命早期的麻醉以及随后的学习异常之间存在联系。概述暴露在麻醉剂和镇静剂中的神经变性在发育中的动物中已明确确立。然而，虽然一些生化途径已经被揭示，但这种现象的特殊分子机制仍然不清楚。由于这种现象在人类中很难研究，临床证据仍然很少，而且相当于关联关系，而不是因果关系。由于缺乏可替代的麻醉药，迫切需要进一步的动物研究和临床研究来确定人类的敏感性。
Purpose of reviewGeneral anesthetics and sedatives are used in millions of children every year to facilitate surgical procedures, imaging studies, and sedation in operating rooms, radiology suites, emergency departments, and ICUs. Mounting evidence from animal studies suggests that prolonged exposure to these compounds may induce widespread neuronal cell death and neurological sequelae, seriously questioning the safety of pediatric anesthesia. This review presents recent developments in this rapidly emerging field.Recent findingsIn animals, all currently available anesthetics and sedatives that have been studied, such as ketamine, midazolam, diazepam, clonazepam, propofol, pentobarbital, chloral hydrate, halothane, isoflurane, sevoflurane, enflurane, nitrous oxide, and xenon, have been demonstrated to trigger widespread neurodegeneration in the immature brain. In humans, recent preliminary findings from epidemiological studies suggest an association between surgery and anesthesia early in life and subsequent learning abnormalities.SummaryNeurodegeneration following exposure to anesthetics and sedatives has been clearly established in developing animals. However, while some of the biochemical pathways have been revealed, the phenomenon's particular molecular mechanisms remain unclear. As the phenomenon is difficult to study in humans, clinical evidence is still scarce and amounts to associative and not causal relationships. Owing to the lack of alternative anesthetics, further animal studies into the mechanism as well as clinical studies defining human susceptibility are both urgently needed.