From the Department of Anesthesia and Pain Management, Royal Children's Hospital, the Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Melbourne, Australia (A.J.D.); and the College of Physicians and Surgeons, Columbia University, New York, New York (L.S.S.).
Anesthesiology. 2018 Apr;128(4):840-853. doi: 10.1097/ALN.0000000000001972.
A recent U.S. Food and Drug Administration warning advised that prolonged or repeated exposure to general anesthetics may affect neurodevelopment in children. This warning is based on a wealth of preclinical animal studies and relatively few human studies. The human studies include a variety of different populations with several different outcome measures. Interpreting the results requires consideration of the outcome used, the power of the study, the length of exposure and the efforts to reduce the confounding effects of comorbidity and surgery. Most, but not all, of the large population-based studies find evidence for associations between surgery in early childhood and slightly worse subsequent academic achievement or increased risk for later diagnosis of a behavioral disability. In several studies, the amount of added risk is very small; however, there is some evidence for a greater association with multiple exposures. These results may be consistent with the preclinical data, but the possibility of confounding means the positive associations can only be regarded as weak evidence for causation. Finally, there is strong evidence that brief exposure is not associated with any long term risk in humans.
美国食品和药物管理局最近发布的一则警告称，儿童长时间或反复接触全身麻醉可能会影响神经发育。这一警告是基于大量的临床前动物研究和相对较少的人体研究得出的。这些人体研究包括多种不同人群，采用了多种不同的结果衡量标准。解释结果需要考虑使用的结果、研究的力度、暴露的时间长度以及减少合并症和手术混杂影响的努力。大多数（但不是全部）基于人群的大型研究发现，儿童早期手术与随后学业成绩略差或日后被诊断为行为障碍的风险增加之间存在关联的证据。在一些研究中，风险增加的幅度很小；然而，有一些证据表明，多次暴露的关联更大。这些结果与临床前数据一致，但混杂的可能性意味着阳性关联只能被视为因果关系的微弱证据。最后，有强有力的证据表明，短暂暴露与人类的任何长期风险无关。
