Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome.
Increasing cumulative exposure to volatile anesthetic agents is associated with poorer neurodevelopmental outcomes in children with hypoplastic left heart syndrome.
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DOI：
10.1016/j.jtcvs.2016.03.095
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Nicolson SC
中科院分区：
文献类型：
--
作者：
Diaz LK;Gaynor JW;Koh SJ;Ittenbach RF;Gerdes M;Bernbaum JC;Zackai EH;Clancy RR;Rehman MA;Pennington JW;Burnham N;Spray TL;Nicolson SC
尽管左心发育不良综合征(HLHS)儿童的存活率有所提高，但人们仍然对他们的神经发育(ND)结果感到担忧。以前的研究已经确定了患者因素，如早产和遗传综合征，与较差的ND结果相关。然而，在包括体外循环策略在内的可改变的管理因素和婴儿期心脏手术后ND结果之间还没有确定一致的关系。对包括灵长类动物在内的未成熟动物的研究表明，在一定水平和较长时间的麻醉剂暴露后，大脑中的神经退化和细胞凋亡。回溯性的人体研究也表明了不良新城疫效应与麻醉暴露之间的关系。从麻醉数据库和96例HLHS患者的病历回顾中收集了暴露于挥发性麻醉剂(VAA)(地氟烷、氟烷、异氟烷和七氟烷)的累积最低肺泡浓度小时数(MAC-HRS)。测试对象为4-5岁儿童，包括全量智商、言语智商、操作智商和加工速度。先验假设了四个广义线性模型，并使用带有同一性链接的高斯(正态)分布进行了检验。累积VAA暴露范围从0到35.3MAC-小时(中位数7.5小时)。使用以前被确定为ND结果的显著预测因素的特定协变量，仅在调整了相关协变量后，在总MAC-hrS暴露与较差的全量智商和言语智商分数(p‘s<；0.05)之间识别出具有统计学意义的关系。在患有HLHS及其变异体的儿童中，累积暴露于VAA的MAC-HRs增加与某些领域的ND预后较差有关。
Despite improved survival in children with hypoplastic left heart syndrome (HLHS), significant concern persists regarding their neurodevelopmental (ND) outcomes. Previous studies have identified patient factors, such as prematurity and genetic syndromes, to be associated with worse ND outcomes. However, no consistent relationships have been identified among modifiable management factors, including cardiopulmonary bypass strategies, and ND outcomes after cardiac surgery in infancy. Studies in immature animals, including primates, have demonstrated neurodegeneration and apoptosis in the brain after certain levels and extended durations of anesthetic exposure. Retrospective human studies have also suggested relationships between adverse ND effects and anesthetic exposure. Cumulative minimum alveolar concentration hours (MAC-hrs) of exposure to volatile anesthetic agents (VAA) (desflurane, halothane, isoflurane and sevoflurane) were collected from an anesthetic database and medical record review for 96 patients with HLHS or variants. ND testing was performed between ages 4 and 5 years including full-scale IQ, verbal IQ, performance IQ and processing speed. Four generalized linear modes were hypothesized a priori and tested using a Gaussian (normal) distribution with an identity link. Cumulative VAA exposure ranged from 0 to 35.3 MAC-hrs (median 7.5 hrs). Using specified covariates identified previously as significant predictors of ND outcomes, statistically significant relationships were identified between total MAC-hrs exposure and worse full-scale IQ and verbal IQ scores (p’s < 0.05) alone and after adjusting for relevant covariates. Increased cumulative MAC-hrs exposure to VAA is associated with worse ND outcomes in certain domains in children with HLHS and variants.
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DOI：
10.1016/j.jtcvs.2013.12.019
发表时间：
2014-04
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Gaynor JW;Ittenbach RF;Gerdes M;Bernbaum J;Clancy RR;McDonald-McGinn DM;Zackai EH;Wernovsky G;Nicolson SC;Spray TL
通讯作者：
Spray TL
影响因子：
6.4
作者：
Rizzi, Sabina;Carter, Lisa B.;Jevtovic-Todorovic, Vesna
通讯作者：
Jevtovic-Todorovic, Vesna
影响因子：
8.8
作者：
LERMAN, J;SIKICH, N;YENTIS, S
通讯作者：
YENTIS, S
影响因子：
5.7
作者：
DiMaggio C;Sun LS;Li G
通讯作者：
Li G
影响因子：
3.4
作者：
Fuller, Stephanie;Nord, Alex S.;Gaynor, James William
通讯作者：
Gaynor, James William