Neuroprotection and neurotoxicity in the developing brain: an update on the effects of dexmedetomidine and xenon
Neuroprotection and neurotoxicity in the developing brain: an update on the effects of dexmedetomidine and xenon
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DOI：
10.1016/j.ntt.2017.01.001
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发表时间：
2017-03-01
影响因子：
2.9
通讯作者：
Ma, Daqing
中科院分区：
文献类型：
--
作者：
Alam, Azeem;Suen, Ka Chun;Ma, Daqing
越来越多和一致的临床前证据，结合早期临床流行病学观察，表明常用麻醉剂在发育中的大脑中具有潜在的神经毒性作用。这促使FDA对所有批准用于三岁以下儿童的镇静剂和麻醉剂发出安全警告。最近的研究已经确定了右旋美托咪啶（强效α 2-肾上腺素受体激动剂）和氙（惰性气体）作为有效的麻醉佐剂，对发育中的大脑神经毒性较小，并且在新生儿和其他急性持续性神经损伤的情况下具有神经保护特性。右美托咪定和氙是有效的麻醉辅助剂，其神经毒性似乎低于其他现有药物，并且在新生儿和儿科环境中具有神经保护潜力。尽管最近的临床试验和病例报告的结果表明氙和右美托咪定具有神经保护潜力，但还需要进行额外的随机临床试验来证实这些研究。通过审查关于右美托咪定和氙的神经保护作用的现有临床前和临床证据，我们希望深入了解这些药物在儿科手术患者管理中的潜在临床疗效。(C)2017爱思唯尔公司All rights reserved.
Growing and consistent preclinical evidence, combined with early clinical epidemiological observations, suggest potentially neurotoxic effects of commonly used anesthetic agents in the developing brain. This has prompted the FDA to issue a safety warning for all sedatives and anesthetics approved for use in children under three years of age. Recent studies have identified dexmedetomidine, the potent alpha 2-adrenoceptor agonist, and xenon, the noble gas, as effective anesthetic adjuvants that are both less neurotoxic to the developing brain, and also possess neuroprotective properties in neonatal and other settings of acute ongoing neurologic injury. Dexmedetomidine and xenon are effective anesthetic adjuvants that appear to be less neurotoxic than other existing agents and have the potential to be neuroprotective in the neonatal and pediatric settings. Although results from recent clinical trials and case reports have indicated the neuroprotective potential of xenon and dexmedetomidine, additional randomized clinical trials corroborating these studies are necessary. By reviewing both the existing preclinical and clinical evidence on the neuroprotective effects of dexmedetomidine and xenon, we hope to provide insight into the potential clinical efficacy of these agents in the management of pediatric surgical patients. (C) 2017 Elsevier Inc. All rights reserved.