Gleich Stephen J, Shi Yu, Flick Randall, Zaccariello Michael J, Schroeder Darrell R, Hanson Andrew C, Warner David O
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Paediatr Anaesth. 2021 Mar;31(3):282-289. doi: 10.1111/pan.14106. Epub 2021 Jan 4.
The potential adverse effects of exposures to general anesthesia on the developing human brain remain controversial. It has been hypothesized that hypotension accompanying anesthesia could be contributory. We hypothesized that among children exposed to multiple anesthetics prior to age 3, children developing adverse neurodevelopmental outcomes would be more likely to have intraoperative hypotension.
Two previously published study cohorts were utilized for analysis: the retrospective and prospective Mayo Anesthesia Safety in Kids cohorts. The two lowest consecutive systolic blood pressure measurements were abstracted and standardized by calculating a z-score for noninvasive blood pressure reference ranges for children. The lowest systolic blood pressure z-score (continuous variable) and intraoperative hypotension (lowest systolic blood pressure z-score <-1.0) were used to assess the association of intraoperative hypotension with the incidence of learning disabilities or attention-deficit/hyperactivity disorder(retrospective cohort) and factor scores/cluster membership (prospective cohort).
One hunderd and sixteen and 206 children with multiple exposures to general anesthesia were analyzed in the retrospective and prospective cohorts with mean lowest systolic blood pressure z-scores -0.26 (SD 1.02) and -0.62 (SD 1.10), respectively. There was no overall association of the lowest z-score or hypotension with learning disabilities or attention-deficit/hyperactivity disorder in the retrospective cohort. In the prospective cohort, there was no overall association of the lowest systolic blood pressure or hypotension with factor scores or cluster membership.
We did not find evidence to support the hypothesis that, among children exposed to multiple anesthetics prior to age 3, children developing adverse neurodevelopmental outcomes would be more likely to have intraoperative hypotension compared with those who did not.
全身麻醉暴露对发育中的人类大脑的潜在不良影响仍存在争议。有人推测麻醉伴随的低血压可能是一个因素。我们假设，在3岁之前接受多次麻醉的儿童中，出现不良神经发育结局的儿童更有可能术中出现低血压。
利用两个先前发表的研究队列进行分析：梅奥儿童麻醉安全性回顾性队列和前瞻性队列。提取连续两次最低收缩压测量值，并通过计算儿童无创血压参考范围的z分数进行标准化。最低收缩压z分数（连续变量）和术中低血压（最低收缩压z分数<-1.0）用于评估术中低血压与学习障碍或注意力缺陷多动障碍发病率（回顾性队列）以及因子得分/聚类成员（前瞻性队列）之间的关联。
回顾性队列和前瞻性队列中分别分析了116名和206名多次接受全身麻醉的儿童，平均最低收缩压z分数分别为-0.26（标准差1.02）和-0.62（标准差1.10）。在回顾性队列中，最低z分数或低血压与学习障碍或注意力缺陷多动障碍之间没有总体关联。在前瞻性队列中，最低收缩压或低血压与因子得分或聚类成员之间没有总体关联。
我们没有找到证据支持以下假设：在3岁之前接受多次麻醉的儿童中，与未出现不良神经发育结局的儿童相比，出现不良神经发育结局的儿童术中更有可能出现低血压。
