From the Department of Anesthesiology (C.H.I., L.S.S.) and Department of Pediatrics (L.S.S.), Columbia University College of Physicians and Surgeons, New York, New York; Departments of Anesthesiology and Epidemiology (C.J.D., J.E.B., G.L.) and Departments of Psychiatry and Biostatistics (M.M.W.), Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, New York; Centre for Health Services Research, School of Population Health, University of Western Australia, Perth, Australia (E.M.); Centre for Child Health Research, Telethon Institute for Child Health Research, University of Western Australia, Perth, Australia (A.J.W.); Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia (M.K.H.); Department of Psychiatry, New York State Psychiatric Institute, New York, New York (T.F.); School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia and Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia (B.S.v.U.-S.); Department of Anaesthesia, Murdoch Childrens Research Institute and Royal Children's Hospital, Melbourne, Australia (A.J.D.); and Department of Medicine, Weill Cornell College of Medicine, and Symphony Capital LLC, New York, New York (A.J.J.W.).
Anesthesiology. 2014 Jun;120(6):1319-32. doi: 10.1097/ALN.0000000000000248.
Immature animals exposed to anesthesia display apoptotic neurodegeneration and neurobehavioral deficits. The safety of anesthetic agents in children has been evaluated using a variety of neurodevelopmental outcome measures with varied results.
The authors used data from the Western Australian Pregnancy Cohort (Raine) Study to examine the association between exposure to anesthesia in children younger than 3 yr of age and three types of outcomes at age of 10 yr: neuropsychological testing, International Classification of Diseases, 9th Revision, Clinical Modification-coded clinical disorders, and academic achievement. The authors' primary analysis was restricted to children with data for all outcomes and covariates from the total cohort of 2,868 children born from 1989 to 1992. The authors used a modified multivariable Poisson regression model to determine the adjusted association of anesthesia exposure with outcomes.
Of 781 children studied, 112 had anesthesia exposure. The incidence of deficit ranged from 5.1 to 7.8% in neuropsychological tests, 14.6 to 29.5% in International Classification of Diseases, 9th Revision, Clinical Modification-coded outcomes, and 4.2 to 11.8% in academic achievement tests. Compared with unexposed peers, exposed children had an increased risk of deficit in neuropsychological language assessments (Clinical Evaluation of Language Fundamentals Total Score: adjusted risk ratio, 2.47; 95% CI, 1.41 to 4.33, Clinical Evaluation of Language Fundamentals Receptive Language Score: adjusted risk ratio, 2.23; 95% CI, 1.19 to 4.18, and Clinical Evaluation of Language Fundamentals Expressive Language Score: adjusted risk ratio, 2.00; 95% CI, 1.08 to 3.68) and International Classification of Diseases, 9th Revision, Clinical Modification-coded language and cognitive disorders (adjusted risk ratio, 1.57; 95% CI, 1.18 to 2.10), but not academic achievement scores.
When assessing cognition in children with early exposure to anesthesia, the results may depend on the outcome measure used. Neuropsychological and International Classification of Diseases, 9th Revision, Clinical Modification-coded clinical outcomes showed an increased risk of deficit in exposed children compared with that in unexposed children, whereas academic achievement scores did not. This may explain some of the variation in the literature and underscores the importance of the outcome measures when interpreting studies of cognitive function.
在接受麻醉的未成年动物中，会出现凋亡性神经退行性病变和神经行为缺陷。通过使用各种神经发育结局评估方法，已经对儿童用麻醉剂的安全性进行了评估，但其结果各不相同。
作者使用西澳大利亚妊娠队列（Raine）研究的数据，检查了 3 岁以下儿童接触麻醉与 10 岁时三种结局的相关性：神经心理学测试、国际疾病分类，第 9 修订版，临床修正编码的临床疾病，以及学业成绩。作者的主要分析仅限于总队列（2868 名 1989 年至 1992 年出生的儿童）中所有结局和协变量数据的儿童。作者使用改良的多变量泊松回归模型来确定麻醉暴露与结局之间的调整关联。
在 781 名研究的儿童中，有 112 名接受了麻醉。神经心理学测试的缺陷发生率为 5.1%至 7.8%，国际疾病分类，第 9 修订版，临床修正编码的结局为 14.6%至 29.5%，学业成绩测试为 4.2%至 11.8%。与未暴露的同龄人相比，暴露的儿童在神经心理学语言评估中出现缺陷的风险增加（综合语言基础临床评估总分：调整后的风险比，2.47；95%置信区间，1.41 至 4.33，综合语言基础临床评估接受性语言评分：调整后的风险比，2.23；95%置信区间，1.19 至 4.18，综合语言基础临床评估表达性语言评分：调整后的风险比，2.00；95%置信区间，1.08 至 3.68）和国际疾病分类，第 9 修订版，临床修正编码的语言和认知障碍（调整后的风险比，1.57；95%置信区间，1.18 至 2.10），但学业成绩没有。
在评估早期接触麻醉的儿童认知功能时，结果可能取决于使用的结局评估方法。与未暴露的儿童相比，神经心理学和国际疾病分类，第 9 修订版，临床修正编码的临床结局显示暴露的儿童出现缺陷的风险增加，而学业成绩则没有。这可能解释了文献中的一些差异，并强调了在解释认知功能研究时，结局评估的重要性。
