Department of Neurology.
Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2019 Apr;31(2):267-273. doi: 10.1097/MOP.0000000000000737.
Compelling evidence in animal models that, under some conditions, general anesthetics and sedatives produce changes in the brain and persistent impairments in learning, memory, and behavior. The present review summarizes recent clinical studies investigating whether the use of these agents in children causes similar neurotoxicities.
Although the results of retrospective studies are somewhat mixed, multiple exposures to general anesthesia were generally found to confer greater risk than single exposures with regard to learning disability, attention deficit hyperactivity disorder, school readiness, and academic achievement. Recent clinical studies, including a large randomized controlled trial, are consistent in confirming that a single exposure in infancy to general anesthesia lasting less than 1 h is not associated with neurodevelopmental impairments in later childhood. These studies do not, however, clarify the potential impacts of longer exposures or multiple exposures.
Given that approximately half of the anesthetic exposures in young US children are 1 h or less in duration, the results of the recent clinical studies are reassuring. Because of the clinical necessity of administering general anesthetics and sedatives for longer periods for many surgical, procedural, or diagnostic purposes, the identification of adjuvants that prevent or reduce the potential neurotoxicity of these agents is an area of active research.
动物模型中有强有力的证据表明，在某些情况下，全身麻醉剂和镇静剂会导致大脑发生变化，并持续损害学习、记忆和行为能力。本综述总结了最近的临床研究，这些研究调查了这些药物在儿童中的使用是否会引起类似的神经毒性。
尽管回顾性研究的结果有些混杂，但多项研究发现，多次接触全身麻醉与单次接触相比，更有可能导致学习障碍、注意缺陷多动障碍、入学准备和学业成绩下降。最近的临床研究，包括一项大型随机对照试验，一致证实婴儿期单次接触持续时间不到 1 小时的全身麻醉不会导致儿童后期的神经发育障碍。然而，这些研究并不能阐明更长时间暴露或多次暴露的潜在影响。
鉴于美国儿童中约有一半的麻醉暴露时间为 1 小时或更短，最近的临床研究结果令人安心。由于出于许多手术、程序或诊断目的的临床需要，需要使用全身麻醉剂和镇静剂更长时间，因此寻找预防或减少这些药物潜在神经毒性的佐剂是一个活跃的研究领域。
