Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.
Biol Reprod. 2021 Sep 14;105(3):735-746. doi: 10.1093/biolre/ioab129.
Most surgical procedures require general anesthesia, which is a reversible deep sedation state lacking all perception. The induction of this state is possible because of complex molecular and neuronal network actions of general anesthetics (GAs) and other pharmacological agents. Laboratory and clinical studies indicate that the effects of GAs may not be completely reversible upon anesthesia withdrawal. The long-term neurocognitive effects of GAs, especially when administered at the extremes of ages, are an increasingly recognized health concern and the subject of extensive laboratory and clinical research. Initial studies in rodents suggest that the adverse effects of GAs, whose actions involve enhancement of GABA type A receptor activity (GABAergic GAs), can also extend to future unexposed offspring. Importantly, experimental findings show that GABAergic GAs may induce heritable effects when administered from the early postnatal period to at least young adulthood, covering nearly all age groups that may have children after exposure to anesthesia. More studies are needed to understand when and how the clinical use of GAs in a large and growing population of patients can result in lower resilience to diseases in the even larger population of their unexposed offspring. This minireview is focused on the authors' published results and data in the literature supporting the notion that GABAergic GAs, in particular sevoflurane, may upregulate systemic levels of stress and sex steroids and alter expressions of genes that are essential for the functioning of these steroid systems. The authors hypothesize that stress and sex steroids are involved in the mediation of sex-specific heritable effects of sevoflurane.
大多数外科手术都需要全身麻醉,这是一种深度镇静状态,患者会失去所有知觉。全身麻醉(GA)和其他药理学药物的复杂分子和神经元网络作用使得这种状态可以被诱导。实验室和临床研究表明,全身麻醉药物的作用在麻醉解除后可能并非完全可逆。全身麻醉药物的长期神经认知效应,特别是在儿童和老年人群中使用时,是一个日益受到关注的健康问题,也是广泛的实验室和临床研究的主题。在啮齿动物中的初步研究表明,GA 的不良反应(其作用涉及增强 GABA 型 A 受体活性(GABAergic GAs))也可能会扩展到未来未暴露的后代。重要的是,实验结果表明,当从新生儿期到至少成年早期给予 GABAergic GAs 时,可能会导致可育后代具有遗传效应,这几乎涵盖了所有在接触麻醉后可能生育子女的年龄组。需要更多的研究来了解在大量且不断增长的患者群体中使用 GA 会在多大程度上以及如何导致其未暴露的后代对疾病的抵抗力降低,从而在更大的人群中产生影响。这篇综述文章主要关注作者发表的结果和文献中的数据,这些结果和数据支持了这样一种观点,即 GABAergic GAs(特别是七氟醚)可能会上调系统性应激和性激素水平,并改变这些类固醇系统功能所必需的基因表达。作者假设应激和性激素参与了七氟醚的性别特异性遗传效应的介导。