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为何我们在发育中的大脑中运用成人麻醉药理学概念？这会对结果产生影响吗？小儿麻醉中神经监测与药理学面临的挑战。

Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia.

作者信息

Sepúlveda Pablo O, Epulef Valeria, Campos Gustavo

机构信息

Hospital Base San José de Osorno, Service Anesthesiology and Pain, Faculty of Medicine, University Austral, Los Lagos 529000, Chile.

Department of Surgery, Traumatology and Anesthesiology, Medicine Faculty, Universidad de La Frontera, Temuco 4780000, Chile.

出版信息

J Clin Med. 2021 May 18;10(10):2175. doi: 10.3390/jcm10102175.

DOI:10.3390/jcm10102175
PMID:34069896
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8157588/
Abstract

Pediatric sedation and anesthesia techniques have plenty of difficulties and challenges. Data on the pharmacologic, electroencephalographic, and neurologic response to anesthesia at different brain development times are only partially known. New data in neuroscience, pharmacology, and intraoperative neuromonitoring will impact changing concepts and clinical practice. In this article, we develop a conversation to guide the debate and search for a view more attuned to the updated knowledge in neurodevelopment, electroencephalography, and clinical pharmacology for the anesthesiologic practice in the pediatric population.

摘要

儿科镇静和麻醉技术存在诸多困难与挑战。关于不同脑发育时期对麻醉的药理学、脑电图及神经学反应的数据仅部分为人所知。神经科学、药理学及术中神经监测方面的新数据将影响不断变化的概念和临床实践。在本文中，我们展开一场讨论以引导辩论，并寻求一种更符合儿科人群麻醉实践中神经发育、脑电图及临床药理学最新知识的观点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/f16e83fcac47/jcm-10-02175-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/63674797a1ba/jcm-10-02175-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/75ea82ce64bd/jcm-10-02175-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/9e4a8dee64bd/jcm-10-02175-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/f16e83fcac47/jcm-10-02175-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/63674797a1ba/jcm-10-02175-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/75ea82ce64bd/jcm-10-02175-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/9e4a8dee64bd/jcm-10-02175-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b5/8157588/f16e83fcac47/jcm-10-02175-g004.jpg

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Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia.为何我们在发育中的大脑中运用成人麻醉药理学概念？这会对结果产生影响吗？小儿麻醉中神经监测与药理学面临的挑战。
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本文引用的文献

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Prevalence of Isoelectric Electroencephalography Events in Infants and Young Children Undergoing General Anesthesia.在接受全身麻醉的婴儿和幼儿中，等电脑电图事件的发生率。
Anesth Analg. 2020 Feb;130(2):462-471. doi: 10.1213/ANE.0000000000004221.
2
Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children.全凭静脉麻醉和靶控输注在儿童中的应用实践。
Anesthesiology. 2019 Jul;131(1):164-185. doi: 10.1097/ALN.0000000000002657.
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Neural inertia and differences between loss of and recovery from consciousness during total intravenous anaesthesia: a narrative review.
全静脉麻醉期间意识丧失与恢复之间的神经惯性差异：叙述性综述。
Anaesthesia. 2019 Jun;74(6):801-809. doi: 10.1111/anae.14609. Epub 2019 Mar 5.
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Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial.婴幼儿全身麻醉或清醒区域麻醉后 5 岁时的神经发育结局（GAS）：一项国际、多中心、随机、对照等效试验。
Lancet. 2019 Feb 16;393(10172):664-677. doi: 10.1016/S0140-6736(18)32485-1. Epub 2019 Feb 14.
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Electroencephalographic (EEG) density spectral array monitoring in children during sevoflurane anaesthesia: a prospective observational study.七氟醚麻醉期间儿童脑电图（EEG）密度谱数组监测：一项前瞻性观察研究。
Anaesthesia. 2019 Jan;74(1):45-50. doi: 10.1111/anae.14458. Epub 2018 Oct 27.
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Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study.小儿全身麻醉下接受手术治疗后的神经心理学和行为学结果：梅奥小儿麻醉安全（MASK）研究。
Anesthesiology. 2018 Jul;129(1):89-105. doi: 10.1097/ALN.0000000000002232.
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Clinical Evidence for Any Effect of Anesthesia on the Developing Brain.临床证据表明麻醉对发育中大脑无任何影响。
Anesthesiology. 2018 Apr;128(4):840-853. doi: 10.1097/ALN.0000000000001972.
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Evidence of hysteresis in propofol pharmacodynamics.丙泊酚药效动力学滞后的证据。
Anaesthesia. 2018 Jan;73(1):40-48. doi: 10.1111/anae.14009. Epub 2017 Sep 5.
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Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort.基于人群的出生队列中幼儿接受全身麻醉手术暴露与学习及行为结果之间的关联。
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Climbing Brain Levels of Organisation from Genes to Consciousness.从基因到意识，攀登大脑组织层次。
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