Department of Anaesthesia and Intensive Care, University Hospital Odense, Odense, Denmark; University of Southern Denmark, Department of Clinical Research, Odense, Denmark; Children's Hospital University of Zürich, Department of Anaesthesia, Zürich, Switzerland.
Department of Anaesthesia and Intensive Care, University Hospital Odense, Odense, Denmark.
Br J Anaesth. 2018 Jun;120(6):1255-1273. doi: 10.1016/j.bja.2017.11.107. Epub 2018 Feb 3.
Neurotoxicity of anaesthetics in developing brain cells is well documented in preclinical studies, yet results are conflicting in humans. The use of many and different outcome measures in human studies may contribute to this disagreement.
We conducted a systematic review to identify all measures used to assess long-term neurocognitive outcomes following general anaesthesia (GA) and surgery in children. The quality of studies was assessed according to the Newcastle-Ottawa Scale (NOS) for observational studies. PubMed/MEDLINE, EMBASE, Cinahl, Web of Science, and the Cochrane Library were searched for studies investigating neurocognitive outcome after GA in children <18 yr.
Sixty-seven studies were identified from 19 countries during 1990-2017. Most assessments were performed within cognition, sensory-motor development, academic achievement or neuropsychological diagnosis. Few studies assessed other outcomes (magnetic resonance imaging, serum-biomarkers, mortality, neurological examination, measurement of head circumference, impairment of vision). Rating according to the NOS rewarded a mean of six stars out of nine. Some concerns prevail regarding potential inter-rater variability because of equivocal description of rating criteria. Specific features such as stability over lifetime and inter-relations of outcomes (e.g. prediction of subsequent development or diagnosis of neuropsychological conditions) are discussed. The importance of validity and reliability of the various test instruments are described. The studies vary immensely in important characteristics.
Future observational studies should be more consistent in the choice of study population, age at exposure, follow-up, indication for and type of surgery, and outcomes. Assessment of sensory-motor development seems feasible in young children (age <4 yr), and intelligence/cognition in older children.
在临床前研究中，麻醉剂对发育中脑细胞的神经毒性已有充分的记载，但在人类中结果却存在争议。在人类研究中使用了许多不同的结局指标，这可能是造成这种分歧的原因之一。
我们进行了一项系统评价，以确定所有用于评估儿童全身麻醉（GA）和手术后脑神经认知结局的测量方法。根据观察性研究的纽卡斯尔-渥太华量表（NOS）对研究质量进行评估。我们检索了 1990 年至 2017 年期间来自 19 个国家的研究，以调查儿童 GA 后神经认知结果。
从 19 个国家中确定了 67 项研究。大多数评估是在认知、感觉运动发育、学业成绩或神经心理学诊断方面进行的。很少有研究评估其他结局（磁共振成像、血清生物标志物、死亡率、神经检查、头围测量、视力损害）。根据 NOS 评分，平均得分为 9 分中的 6 分。由于评分标准描述不明确，可能存在观察者间变异性，这引起了一些关注。还讨论了其他问题，如终身稳定性以及结局之间的相互关系（例如对后续发育的预测或神经心理状况的诊断）。还描述了各种测试仪器的有效性和可靠性的重要性。这些研究在重要特征上存在巨大差异。
未来的观察性研究应在研究人群、暴露年龄、随访时间、手术适应证和类型以及结局的选择上更加一致。在年龄较小的儿童（<4 岁）中，感觉运动发育的评估似乎是可行的，而在年龄较大的儿童中，智力/认知的评估是可行的。
