Houck Constance S, Vinson Amy E
Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Arch Dis Child Fetal Neonatal Ed. 2017 Jul;102(4):F359-F363. doi: 10.1136/archdischild-2016-311800. Epub 2017 Mar 10.
Almost 30 years ago, the American Academy of Pediatrics Committee on Fetus and Newborn coauthored a policy statement strongly advocating for the use of anaesthesia in all neonates stating 'local or systemic pharmacologic agents now available permit relatively safe administration of anesthesia or analgesia to neonates undergoing surgical procedures and that such administration is indicated according to the usual guidelines for the administration of anesthesia to high-risk, potentially unstable patients'. With current techniques and advanced monitoring, preterm and full-term infants routinely undergo surgical procedures under general anaesthesia to repair congenital defects that were lethal in years past. Recent research in immature animal models, however, has shown evidence of enhanced neuroapoptosis and other signs of neurotoxicity with all of the currently used anaesthetic agents. There is also increasing concern about the potential adverse effects of perioperative hypotension and hypocapnia on neurocognitive development in infants. This review outlines the most recent animal and human evidence regarding the effects of general anaesthesia and anaesthetic-related haemodynamic changes on the developing brain of newborns.
大约30年前，美国儿科学会胎儿与新生儿委员会共同撰写了一份政策声明，强烈主张对所有新生儿使用麻醉，声明称“现有的局部或全身药理学药物允许对接受外科手术的新生儿相对安全地实施麻醉或镇痛，并且这种给药应根据对高危、潜在不稳定患者实施麻醉的常规指南进行”。凭借当前的技术和先进的监测手段，早产和足月婴儿现在常规在全身麻醉下接受外科手术，以修复过去曾是致命的先天性缺陷。然而，最近在未成熟动物模型中的研究表明，目前所有使用的麻醉剂都有增强神经细胞凋亡及其他神经毒性迹象的证据。人们也越来越关注围手术期低血压和低碳酸血症对婴儿神经认知发育的潜在不良影响。这篇综述概述了关于全身麻醉及麻醉相关血流动力学变化对新生儿发育中大脑影响的最新动物和人体证据。
