Apai Carol, Shah Rohan, Tran Khoa, Pandya Shah Shridevi
Department of Anesthesiology, New Jersey Medical School, Division of Biomedical and Health Sciences, Rutgers University, Newark, NJ, USA.
Department of Anesthesiology, Keck Hospital, Keck Medicine of the University of Southern California, Los Angeles, CA, USA.
Clin Ther. 2021 Apr;43(4):762-778. doi: 10.1016/j.clinthera.2021.01.024. Epub 2021 Mar 3.
For over 150 years of anesthetic practice, it was believed that the effects of general anesthetics were temporary and not adverse. A growing number of studies over the past 2 decades, however, have identified structural and cognitive abnormalities, especially in the developing brain. Despite the growing evidence of anesthetic-induced neurotoxicity in animal studies, the evidence to date in humans has been inconsistent and unclear. Sevoflurane, a commonly used inhalational agent in pediatric anesthesia, is an agent of choice for inhalational induction due to its rapid activity and low blood-gas solubility. With evaluation of the current literature, improved considerations can be made regarding the widespread use of sevoflurane as an anesthetic.
PubMed database was searched for article published between 1969 through 2020. The reference lists of identified articles were searched manually for additional papers eligible for inclusion. This review addressed the tolerability of sevoflurane in specific populations, particularly pediatrics, and is divided into 3 parts: (1) the history of sevoflurane use in anesthetic practice and the pharmacokinetic properties that make it advantageous in pediatric populations; (2) proposed mechanisms of anesthesia-induced neurotoxicity; and (3) considerations due to potential adverse effects of sevoflurane in both short and long procedures.
There is reason for concern regarding the neurotoxic effects of sevoflurane in both the pediatric and elderly populations, as spatial memory loss, developmental deficits, and an enhanced risk for Alzheimer disease have been linked with the use of this popular inhalational agent.
The duration and dose of sevoflurane may need to be altered, especially in longer procedures in pediatric populations. This may change how sevoflurane is administered, thus indicating a greater demand for an understanding of its limitations as an anesthetic agent.
在超过150年的麻醉实践中，人们一直认为全身麻醉药的作用是暂时的且无不良影响。然而，在过去20年中，越来越多的研究发现了结构和认知异常，尤其是在发育中的大脑中。尽管在动物研究中越来越多的证据表明麻醉药会导致神经毒性，但迄今为止在人类中的证据一直不一致且不明确。七氟烷是儿科麻醉中常用的吸入麻醉剂，由于其起效迅速且血气溶解度低，是吸入诱导的首选药物。通过对当前文献的评估，可以对七氟烷作为麻醉剂的广泛使用进行更好的考量。
在PubMed数据库中搜索1969年至2020年发表的文章。手动搜索已识别文章的参考文献列表以查找其他符合纳入标准的论文。本综述探讨了七氟烷在特定人群，特别是儿科人群中的耐受性，并分为三个部分：（1）七氟烷在麻醉实践中的使用历史以及使其在儿科人群中具有优势的药代动力学特性；（2）麻醉诱导神经毒性的潜在机制；（3）七氟烷在短期和长期手术中潜在不良反应的考量。
七氟烷在儿科和老年人群中的神经毒性作用令人担忧，因为空间记忆丧失、发育缺陷以及患阿尔茨海默病的风险增加都与这种常用吸入麻醉剂的使用有关。
七氟烷的使用时长和剂量可能需要调整，尤其是在儿科人群的较长手术中。这可能会改变七氟烷的给药方式，从而表明更需要了解其作为麻醉剂的局限性。
