Department of Anesthesiology and Pediatrics, Columbia University, New York, NY 10032, USA.
Br J Anaesth. 2010 Dec;105 Suppl 1(Suppl 1):i61-8. doi: 10.1093/bja/aeq302.
A great deal of concern has recently arisen regarding the safety of anaesthesia in infants and children. There is mounting and convincing preclinical evidence in rodents and non-human primates that anaesthetics in common clinical use are neurotoxic to the developing brain in vitro and cause long-term neurobehavioural abnormalities in vivo. An estimated 6 million children (including 1.5 million infants) undergo surgery and anaesthesia each year in the USA alone, so the clinical relevance of anaesthetic neurotoxicity is an urgent matter of public health. Clinical studies that have been conducted on the long-term neurodevelopmental effects of anaesthetic agents in infants and children are retrospective analyses of existing data. Two large-scale clinical studies are currently underway to further address this issue. The PANDA study is a large-scale, multisite, ambi-directional sibling-matched cohort study in the USA. The aim of this study is to examine the neurodevelopmental effects of exposure to general anaesthesia during inguinal hernia surgery before 36 months of age. Another large-scale study is the GAS study, which will compare the neurodevelopmental outcome between two anaesthetic techniques, general sevoflurane anaesthesia and regional anaesthesia, in infants undergoing inguinal hernia repair. These study results should contribute significant information related to anaesthetic neurotoxicity in children.
最近，人们对婴儿和儿童麻醉安全性的问题非常关注。越来越多的啮齿动物和非人类灵长类动物的临床前证据表明，在体外，目前临床常用的麻醉剂对发育中的大脑具有神经毒性，并在体内引起长期的神经行为异常。仅在美国，每年就有约 600 万名儿童（包括 150 万名婴儿）接受手术和麻醉，因此麻醉神经毒性的临床相关性是一个紧迫的公共卫生问题。已经对麻醉剂对婴儿和儿童的长期神经发育影响进行了临床研究，这些研究是对现有数据的回顾性分析。目前正在进行两项大型临床研究来进一步解决这个问题。PANDA 研究是美国一项大型、多地点、双向同胞匹配队列研究。该研究的目的是检查在 36 个月之前接受腹股沟疝手术时全身麻醉暴露对神经发育的影响。另一项大型研究是 GAS 研究，该研究将比较全身七氟醚麻醉和区域麻醉两种麻醉技术在接受腹股沟疝修复的婴儿中的神经发育结果。这些研究结果应该为儿童麻醉神经毒性提供重要信息。
