Does general anesthesia affect neurodevelopment in infants and children?

被引:124
作者
McCann, Mary Ellen [1 ,2 ]
Soriano, Sulpicio G. [1 ,2 ]
机构
[1] Harvard Med Sch, Dept Anesthesia, Boston, MA 02115 USA
[2] Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA 02115 USA
来源
BMJ-BRITISH MEDICAL JOURNAL | 2019年 / 367卷
关键词
AWAKE-REGIONAL ANESTHESIA; SEVOFLURANE ANESTHESIA; EMERGENCE DELIRIUM; YOUNG-CHILDREN; ACADEMIC-PERFORMANCE; BEHAVIORAL OUTCOMES; CARDIAC-SURGERY; EARLY EXPOSURE; RECOVERY CHARACTERISTICS; NEUROCOGNITIVE OUTCOMES;
D O I
10.1136/bmj.l6459
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
General anesthesia has been unequivocally linked to abnormal development of the central nervous system, leading to neurocognitive impairments in laboratory models. In vitro and in vivo studies have consistently shown that exposure to GABA agonists (eg, volatile anesthetics, midazolam, and propofol) or NMDA antagonists (eg, ketamine, isoflurane, and nitrous oxide) produces dose dependent and developmental age dependent effects on various neuronal transmission systems. Exposure to these drugs increases neuronal cell death in juvenile animals including rats, mice, and non-human primates. The possibility of anesthetic induced neurotoxicity occurring in children has led to concerns about the safety of pediatric anesthesia. A spectrum of behavioral changes has been documented after general anesthetic exposure in young children, including emergence delirium, which may be evidence of toxicity. Most clinical studies are retrospective; specifics about medications or monitoring are unavailable and many of the outcomes may not be sensitive to detect small neurocognitive deficits. Some of these retrospective studies have shown an association between anesthesia exposure at a young age and neurocognitive deficits, but others have not. Practitioners and families should be reassured that although general anesthetics have the potential to induce neurotoxicity, very little clinical evidence exists to support this.
引用
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页数:12
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