Center for Pain and the Brain, 1 Autumn Street, Boston Children's Hospital, Boston MA 02115, United States; Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
Prog Neurobiol. 2017 Jun;153:121-160. doi: 10.1016/j.pneurobio.2017.01.005. Epub 2017 Feb 8.
Long-term consequences of anesthetic exposure in humans are not well understood. It is possible that alterations in brain function occur beyond the initial anesthetic administration. Research in children and adults has reported cognitive and/or behavioral changes after surgery and general anesthesia that may be short lived in some patients, while in others, such changes may persist. The changes observed in humans are corroborated by a large body of evidence from animal studies that support a role for alterations in neuronal survival (neuroapoptosis) or structure (altered dendritic and glial morphology) and later behavioral deficits at older age after exposure to various anesthetic agents during fetal or early life. The potential of anesthetics to induce long-term alterations in brain function, particularly in vulnerable populations, warrants investigation. In this review, we critically evaluate the available preclinical and clinical data on the developing and aging brain, and in known vulnerable populations to provide insights into potential changes that may affect the general population of patients in a more, subtle manner. In addition this review summarizes underlying processes of how general anesthetics produce changes in the brain at the cellular and systems level and the current understanding underlying mechanisms of anesthetics agents on brain systems. Finally, we present how neuroimaging techniques currently emerge as promising approaches to evaluate and define changes in brain function resulting from anesthesia, both in the short and the long-term.
人类暴露于麻醉剂的长期后果尚不清楚。麻醉药物的作用可能不仅限于初始给药阶段，还可能改变大脑功能。在儿童和成人中进行的研究报告称，手术后和全身麻醉后可能会出现认知和/或行为改变，这些改变在一些患者中可能是短暂的，而在另一些患者中则可能持续存在。动物研究提供了大量证据支持了这些改变，这些改变表明，暴露于各种麻醉剂后，神经元存活（神经细胞凋亡）或结构（树突和神经胶质形态改变）发生改变，并在老年时出现行为缺陷，这在人类中观察到的改变得到了证实。麻醉剂是否有潜力导致大脑功能的长期改变，尤其是在脆弱人群中，值得进一步研究。在这篇综述中，我们批判性地评估了关于发育中和衰老中的大脑以及已知脆弱人群的临床前和临床数据，以深入了解可能以更微妙的方式影响更广泛患者群体的潜在变化。此外，本文还总结了全身麻醉在细胞和系统水平上引起大脑改变的潜在过程，以及麻醉剂对大脑系统作用机制的当前理解。最后，我们介绍了神经影像学技术如何在短期和长期内评估和定义麻醉引起的大脑功能变化。
