Do anesthetics harm the developing human brain? An integrative analysis of animal and human studies
Do anesthetics harm the developing human brain? An integrative analysis of animal and human studies
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麻醉剂会伤害正在发育的人类大脑吗？
DOI：
10.1016/j.ntt.2016.10.008
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发表时间：
2017-03-01
影响因子：
2.9
通讯作者：
Loepke, Andreas W.
中科院分区：
文献类型：
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作者：
Lin, Erica P.;Lee, Jeong-Rim;Loepke, Andreas W.
允许外科手术和应激干预的麻醉药被发现会导致幼年动物大脑结构异常和功能障碍，引起临床医生、父母和政府监管机构对这些药物在幼儿中的安全使用的广泛关注。关键的问题仍然存在，例如发育中的大脑在什么年龄最容易受到麻醉剂暴露的影响，是否存在一个特定的年龄，超过这个年龄麻醉剂对大脑不会产生长期影响，以及是否存在任何不会导致有害影响的特定暴露时间。因此，本分析试图通过将大脑结构和功能的临床前数据与从人类神经认知研究中获得的临床结果进行整合，将越来越多的动物研究(我们确定到目前为止包括440项实验室研究)置于翻译的背景下，目前已超过30项研究。我们的分析表明，没有明确的暴露持续时间阈值，低于该阈值没有发生结构性损伤或随后的认知异常。动物数据没有明确确定一个特定的年龄，超过这个年龄，麻醉剂暴露不会导致任何结构或功能异常。有几种可能的缓解策略被发现，然而，没有发现全麻药一贯缺乏神经退行性变化的特性，可以推荐优于其他麻醉药。因此，当务之急是扩大努力，设计出更安全的麻醉技术和缓解策略，甚至在明确证实每年数百万接受麻醉的幼儿发生大脑发育的长期变化之前。(C)2016 Elsevier Inc.保留所有权利。
Anesthetics that permit surgical procedures and stressful interventions have been found to cause structural brain abnormalities and functional impairment in immature animals, generating extensive concerns among clinicians, parents, and government regulators regarding the safe use of these drugs in young children. Critically important questions remain, such as the exact age at which the developing brain is most vulnerable to the effects of anesthetic exposure, whether a particular age exists beyond which anesthetics are devoid of long-term effects on the brain, and whether any specific exposure duration exists that does not lead to deleterious effects. Accordingly, the present analysis attempts to put the growing body of animal studies, which we identified to include >440 laboratory studies to date, into a translational context, by integrating the preclinical data on brain structure and function with clinical results attained from human neurocognitive studies, which currently exceed 30 studies. Our analysis demonstrated no clear exposure duration threshold below which no structural injury or subsequent cognitive abnormalities occurred. Animal data did not clearly identify a specific age beyond which anesthetic exposure did not cause any structural or functional abnormalities. Several potential mitigating strategies were found, however, no general anesthetic was identified that consistently lacked neurodegenerative properties and could be recommended over other anesthetics. It therefore is imperative, to expand efforts to devise safer anesthetic techniques and mitigating strategies, even before long-term alterations in brain development are unequivocally confirmed to occur in millions of young children undergoing anesthesia every year. (C) 2016 Elsevier Inc. All rights reserved.