Ward Christopher G, Eckenhoff Roderic G
Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Drug Saf. 2016 Jul;39(7):613-26. doi: 10.1007/s40264-016-0415-z.
Numerous preclinical and clinical studies investigating the neurodevelopmental and neurocognitive effects of exposure to anesthesia and the combination of anesthesia and surgery have demonstrated histopathological and both temporary and long-term cognitive and behavioral effects at the extremes of the human age spectrum. Increasing coverage in the lay press for both our youngest and oldest patient populations has led to heightened concerns regarding the potential harmful side effects of almost all commonly used anesthetic drug regimens. Although the majority of information regarding anesthetic risks in the developing brain derives from preclinical work in rodents, research involving the aged brain has identified a well-defined postoperative cognitive phenotype in humans. While preclinical and clinical data appear to support some association between anesthesia and surgery and the development of detrimental cognitive changes in both the developing and the aged brain, correlation between anesthesia and surgery and poor neurological outcomes does not imply causation. Given this information, no single anesthetic or group of anesthetics can be recommended over any other in terms of causing or preventing negative neurocognitive outcomes in either population. This review summarizes the growing body of preclinical and clinical literature dedicated to the detrimental effects of anesthesia on both the developing and the aging brain.
大量临床前和临床研究探讨了接触麻醉剂以及麻醉与手术联合应用对神经发育和神经认知的影响，这些研究表明，在人类年龄范围的两端，存在组织病理学以及短期和长期的认知与行为影响。针对我们最年幼和最年长患者群体的报道在大众媒体上的覆盖面不断增加，这引发了人们对几乎所有常用麻醉药物方案潜在有害副作用的高度关注。尽管关于发育中大脑麻醉风险的大部分信息来自啮齿动物的临床前研究，但涉及老年大脑的研究已经在人类中确定了一种明确的术后认知表型。虽然临床前和临床数据似乎支持麻醉与手术和发育中及老年大脑中有害认知变化的发展之间存在某种关联，但麻醉与手术和不良神经学结果之间的相关性并不意味着存在因果关系。鉴于这些信息，就导致或预防这两个人群中的负面神经认知结果而言，无法推荐某一种麻醉剂或一组麻醉剂优于其他麻醉剂。本综述总结了越来越多致力于探讨麻醉对发育中和衰老大脑有害影响的临床前和临床文献。
