麻醉诱导与苏醒之间不同的神经机制:一篇综述

Distinct Neural Mechanisms Between Anesthesia Induction and Emergence: A Narrative Review.

作者信息

Zhang Donghang, Wei Yiyong

机构信息

From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.

Department of Anesthesiology, Weill Cornell Medicine, New York, New York.

出版信息

Anesth Analg. 2025 Jul 1;141(1):162-171. doi: 10.1213/ANE.0000000000007114. Epub 2024 Jun 11.

Abstract

Anesthesia induction and emergence are critical periods for perioperative safety in the clinic. Traditionally, the emergence from general anesthesia has been recognized as a simple inverse process of induction resulting from the elimination of general anesthetics from the central nervous system. However, accumulated evidence has indicated that anesthesia induction and emergence are not mirror-image processes because of the occurrence of hysteresis/neural inertia in both animals and humans. An increasing number of studies have highlighted the critical role of orexinergic neurons and their involved circuits in the selective regulation of emergence but not the induction of general anesthesia. Moreover, additional brain regions have also been implicated in distinct neural mechanisms for anesthesia induction and emergence, which extends the concept that anesthetic induction and emergence are not antiparallel processes. Here, we reviewed the current literature and summarized the evidence regarding the differential mechanism of neural modulation in anesthesia induction and emergence, which will facilitate the understanding of the underlying neural mechanism for emergence from general anesthesia.

摘要

麻醉诱导和苏醒是临床围手术期安全的关键时期。传统上,全身麻醉的苏醒被认为是诱导的简单逆过程,这是由于全身麻醉药从中枢神经系统消除所致。然而,越来越多的证据表明,由于动物和人类中均出现滞后/神经惰性现象,麻醉诱导和苏醒并非镜像过程。越来越多的研究强调了食欲素能神经元及其相关回路在选择性调节苏醒而非全身麻醉诱导中的关键作用。此外,其他脑区也参与了麻醉诱导和苏醒的不同神经机制,这扩展了麻醉诱导和苏醒并非反平行过程的概念。在此,我们回顾了当前的文献,并总结了有关麻醉诱导和苏醒中神经调节差异机制的证据,这将有助于理解全身麻醉苏醒的潜在神经机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/335d/12140560/2cc8de4a3004/ane-141-162-g001.jpg

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