General anesthesia has been unequivocally linked to abnormal development of the central nervous system, leading to neurocognitive impairments in laboratory models. In vitro and in vivo studies have consistently shown that exposure to GABA agonists (eg, volatile anesthetics, midazolam, and propofol) or NMDA antagonists (eg, ketamine, isoflurane, and nitrous oxide) produces dose dependent and developmental age dependent effects on various neuronal transmission systems. Exposure to these drugs increases neuronal cell death in juvenile animals including rats, mice, and non-human primates. The possibility of anesthetic induced neurotoxicity occurring in children has led to concerns about the safety of pediatric anesthesia. A spectrum of behavioral changes has been documented after general anesthetic exposure in young children, including emergence delirium, which may be evidence of toxicity. Most clinical studies are retrospective; specifics about medications or monitoring are unavailable and many of the outcomes may not be sensitive to detect small neurocognitive deficits. Some of these retrospective studies have shown an association between anesthesia exposure at a young age and neurocognitive deficits, but others have not. Practitioners and families should be reassured that although general anesthetics have the potential to induce neurotoxicity, very little clinical evidence exists to support this.

译文

:全身麻醉已明确地与中枢神经系统的异常发育相关,从而导致实验室模型中的神经认知损害​​。体外和体内研究一致表明,暴露于GABA激动剂(如挥发性麻醉剂,咪达唑仑和丙泊酚)或NMDA拮抗剂(如氯胺酮,异氟烷和一氧化二氮)对各种神经元产生剂量依赖性和发育年龄依赖性。传输系统。接触这些药物会增加幼年动物(包括大鼠,小鼠和非人类灵长类动物)的神经元细胞死亡。麻醉剂引起儿童神经毒性的可能性引起了对小儿麻醉安全性的担忧。已记录了幼儿全身麻醉后的一系列行为变化,包括出现emerge妄,这可能是毒性的证据。大多数临床研究都是回顾性的。无法获得有关药物或监测的详细信息,并且许多结果可能对检测小的神经认知功能障碍并不敏感。这些回顾性研究中的一些研究表明,年轻时的麻醉暴露与神经认知功能障碍之间存在关联,而其他研究则没有。从业者和家庭应该放心,尽管全身麻醉药具有诱发神经毒性的潜力,但很少有临床证据支持这一点。

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