Manatpon Panumart, Kofke W Andrew
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
J Clin Monit Comput. 2018 Aug;32(4):651-666. doi: 10.1007/s10877-017-0077-0. Epub 2017 Nov 2.
Inhaled anesthetics have been utilized mostly for general anesthesia in the operating room and oftentimes for sedation and for treatment of refractory status epilepticus and status asthmaticus in the intensive care unit. These contexts in the ICU setting are related to potential for prolonged administration wherein potential organ toxicity is a concern. Over the last decade, several clinical and animal studies of neurotoxicity attributable to inhaled anesthetics have been emerging, particularly in extremes of age. This review overviews potential for and potential mechanisms of neurotoxicity and systemic toxicity of prolonged inhaled anesthesia and clinical scenarios where inhaled anesthesia has been used in order to assess safety of possible prolonged use for sedation. High dose inhaled agents are associated with postoperative cognitive dysfunction (POCD) and other situations. However, thus far no strong indication of problematic neuro or organ toxicity has been demonstrated after prolonged use of low dose volatile anesthesia.
吸入性麻醉剂主要用于手术室的全身麻醉，在重症监护病房（ICU）中常用于镇静以及治疗难治性癫痫持续状态和哮喘持续状态。在ICU环境下，这些情况与长时间给药的可能性有关，其中潜在的器官毒性是一个问题。在过去十年中，出现了几项关于吸入性麻醉剂所致神经毒性的临床和动物研究，特别是在极端年龄组。这篇综述概述了长时间吸入麻醉的神经毒性和全身毒性的可能性及潜在机制，以及使用吸入麻醉的临床场景，以便评估其用于镇静时可能长时间使用的安全性。高剂量吸入剂与术后认知功能障碍（POCD）及其他情况有关。然而，迄今为止，长时间使用低剂量挥发性麻醉后，尚未发现明显的神经或器官毒性问题。
