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O'Leary JD. Human Studies of Anesthesia-Related Neurotoxicity in Children: A Narrative Review of Recent Additions to the Clinical Literature. Clin Perinatol 2019; 46:637-645. [PMID: 31653299 DOI: 10.1016/j.clp.2019.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2017, the US Food and Drug Administration warned that exposure to anesthetic medicines for lengthy periods of time or over multiple surgeries may affect brain development in children aged less than 3 years. Since then, the clinical literature continues to find mixed evidence of pediatric anesthesia-related neurotoxicity. However, several new human studies provide strong evidence that a single short exposure to general anesthesia in young children does not cause detectable neurocognitive injury by neuropsychological testing. These newer findings are reassuring, but cannot be extrapolated to children who are deemed to be at highest risk of neurologic injury after anesthesia.
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Affiliation(s)
- James D O'Leary
- Department of Anesthesia, University of Toronto, 12th Floor, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada.
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102
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General anesthetic neurotoxicity in the young: Mechanism and prevention. Neurosci Biobehav Rev 2019; 107:883-896. [PMID: 31606415 DOI: 10.1016/j.neubiorev.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/27/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022]
Abstract
General anesthesia (GA) is usually considered to safely induce a reversible unconscious state allowing surgery to be performed without pain. A growing number of studies, in particular pre-clinical studies, however, demonstrate that general anesthetics can cause neuronal death and even long-term neurological deficits. Herein, we report our literature review and meta-analysis data of the neurological outcomes after anesthesia in the young. We also review available mechanistic and epigenetic data of GA exposure related to cognitive impairment per se and the potential preventive strategies including natural herbal compounds to attenuate those side effects. In summary, anesthetic-induced neurotoxicity may be treatable and natural herbal compounds and other medications may have great potential for such use but warrants further study before clinical applications can be initiated.
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103
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Ikonomidou C, Kirvassilis G, Swiney BS, Wang SH, Huffman JN, Williams SL, Masuoka K, Capuano S, Brunner KR, Crosno K, Simmons HS, Mejia AF, Turski CA, Brambrink A, Noguchi KK. Mild hypothermia ameliorates anesthesia toxicity in the neonatal macaque brain. Neurobiol Dis 2019; 130:104489. [PMID: 31175984 PMCID: PMC6689440 DOI: 10.1016/j.nbd.2019.104489] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 01/18/2023] Open
Abstract
Sedatives and anesthetics can injure the developing brain. They cause apoptosis of neurons and oligodendrocytes, impair synaptic plasticity, inhibit neurogenesis and trigger long-term neurocognitive deficits. The projected vulnerable period in humans extends from the third trimester of pregnancy to the third year of life. Despite all concerns, there is no ethically and medically acceptable alternative to the use of sedatives and anesthetics for surgeries and painful interventions. Development of measures that prevent injury while allowing the medications to exert their desired actions has enormous translational value. Here we investigated protective potential of hypothermia against histological toxicity of the anesthetic sevoflurane in the developing nonhuman primate brain. Neonatal rhesus monkeys underwent sevoflurane anesthesia over 5 h. Body temperature was regulated in the normothermic (>36.5 °C), mild hypothermic (35-36.5 °C) and moderately hypothermic (<35 °C) range. Animals were euthanized at 8 h and brains examined immunohistochemically (activated caspase 3) and stereologically to quantify apoptotic neuronal and oligodendroglial death. Sevoflurane anesthesia was well tolerated at all temperatures, with oxygen saturations, end tidal CO2 and blood gases remaining at optimal levels. Compared to controls, sevoflurane exposed brains displayed significant apoptosis in gray and white matter affecting neurons and oligodendrocytes. Mild hypothermia (35-36.5 °C) conferred significant protection from apoptotic brain injury, whereas moderate hypothermia (<35 °C) did not. Hypothermia ameliorates anesthesia-induced apoptosis in the neonatal primate brain within a narrow temperature window (35-36.5 °C). Protection is lost at temperatures below 35 °C. Given the mild degree of cooling needed to achieve significant brain protection, application of our findings to humans should be explored further.
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Affiliation(s)
- Chrysanthy Ikonomidou
- Department of Neurology, School of Medicine, University of Wisconsin, Madison, WI, USA.
| | - George Kirvassilis
- Department of Anesthesiology, School of Medicine, University of Wisconsin, Madison, WI, USA
| | - Brant S Swiney
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Sophie H Wang
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Jacob N Huffman
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Sasha L Williams
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Kobe Masuoka
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Saverio Capuano
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kevin R Brunner
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kristin Crosno
- Wisconsin National Primate Research Center, Madison, WI, USA
| | | | - Andres F Mejia
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Christopher A Turski
- Department of Neurology, School of Medicine, University of Wisconsin, Madison, WI, USA
| | - Ansgar Brambrink
- Department of Anesthesiology, Columbia University, New York Presbyterian Hospital, Irving Medical Center, New York, NY, USA
| | - Kevin K Noguchi
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
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104
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Chai D, Cheng Y, Sun Y, Yan J, Hu R, Zhang L, Jiang H. Multiple sevoflurane exposures during pregnancy inhibit neuronal migration by upregulating prostaglandin D2 synthase. Int J Dev Neurosci 2019; 78:77-82. [PMID: 31499143 DOI: 10.1016/j.ijdevneu.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The second trimester is a period of neurogenesis and neuronal migration, which may be affected by exposure to anesthetics. Studies have suggested that multiple anesthetic exposures may have a significant impact on neuronal migration. METHODS Pregnant C57BL/6 mice at embryonic day 14.5 were randomly divided into four groups: Con x 1, Sev x 1, Con x 2, and Sev x 2. Cortical neuronal migration in offspring mice was detected by GFP immunostaining, and the number of cells in the cortex was analyzed. RESULTS Dual exposure to sevoflurane, not single sevoflurane exposure, caused neuronal migration deficits. Dual exposure to sevoflurane increased the expression of prostaglandin D2 synthase (Ptgds). Furthermore, Ptgds siRNA attenuated neuronal migration deficits induced by dual sevoflurane exposure. CONCLUSION Our study suggests that multiple sevoflurane exposures in pregnant mice may induce neuronal migration deficits in offspring mice. Additional studies comprising long-term behavioral tests are required to confirm the effects of sevoflurane exposure during pregnancy.
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Affiliation(s)
- Dongdong Chai
- Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyong Cheng
- Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Sun
- Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Yan
- Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Hu
- Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Jiang
- Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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105
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Raghuram K, Isaac M, Yang J, AlAli A, Mireskandari K, Ly LG, Kelly E, Banihani R, Shah PS, Tehrani N. Neurodevelopmental outcomes in infants treated with intravitreal bevacizumab versus laser. J Perinatol 2019; 39:1300-1308. [PMID: 31341226 DOI: 10.1038/s41372-019-0420-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/16/2019] [Accepted: 04/27/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare neurodevelopmental and visual outcomes in preterm infants treated with intravitreal bevacizumab (IVB) to laser ablation at 18-24 months corrected age. STUDY DESIGN A retrospective study was performed. The primary outcome was neurodevelopmental impairment (NDI). Secondary neurodevelopmental outcomes were significant NDI (sNDI), cerebral palsy, hearing loss, and composite scores of the Bayley Scales of Infant Development, Third edition. Visual outcomes included structural and refractive outcomes. Adjusted odds ratios (AOR) were calculated controlling for GA, sex, and ROP severity and confounding baseline characteristics using a cutoff of p < 0.20. RESULTS Thirty-four (60 eyes) infants receiving IVB and 30 (51 eyes) laser were included. No significant differences were identified in NDI (AOR 1.77, 95% CI 0.46, 6.73) or sNDI (AOR 2.31, 95% CI 0.75, 7.14). There were no other differences in outcomes. CONCLUSIONS Larger randomized trials are required to establish long-term efficacy and safety of IVB in preterm neonates.
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Affiliation(s)
- Kamini Raghuram
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Maram Isaac
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Alaa AlAli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Linh G Ly
- Division of Neonatology Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Edmond Kelly
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Rudaina Banihani
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nasrin Tehrani
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
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106
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Does general anesthesia or intravitreal injection affect neurodevelopment in children undergoing ophthalmic procedures? Curr Opin Ophthalmol 2019; 30:326-330. [DOI: 10.1097/icu.0000000000000598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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107
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Is Epinephrine Safe for Infant Digit Excision? A Retrospective Review of 402 Polydactyly Excisions in Patients Younger than 6 Months. Plast Reconstr Surg 2019; 144:149-154. [DOI: 10.1097/prs.0000000000005719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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108
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Li G, Du J, Wang L, Shi X. Developmental neurotoxicity in the context of multiple sevoflurane exposures: Potential role of histone deacetylase 6. Neurotoxicol Teratol 2019; 74:106813. [PMID: 31251981 DOI: 10.1016/j.ntt.2019.106813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 05/26/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
Animal studies have demonstrated that multiple exposures to sevoflurane during the postnatal period lead to impaired synaptogenesis and cognitive deficits in adulthood. However, the underlying mechanisms remain unclear. Histone deacetylase 6 (HDAC6), a unique isoform of class II histone deacetylases (HDACs), mediates diverse cellular processes such as cell survival, inflammation, intracellular trafficking and protein degradation. Varieties of literature suggest the importance of HDAC6 in memory formation and abnormal neurodegenerative diseases. The aim of this study was to investigate potential roles of HDAC6 in sevoflurane-induced developmental neurotoxicity. Postnatal day 7 (P7) rat pups were randomly assigned to control group and sevoflurane group (n = 6 for each group). They were exposed to 60% oxygen and 40% nitrogen with or without 3% sevoflurane for 2 h daily for three consecutive days (P7, P8 and P9). Immediately after the last exposure, both hippocampi were harvested for detection of HDAC6 expression and activity. Next, P7 rat pups were divided into control group, sevoflurane group, sevoflurane + Tubastatin A, and Tubastatin A groups (n = 6 for each group in molecular experiments; n = 16 for each group in behavioral testing). A dose of 25 mg/kg body weight of Tubastatin A (a selective HDAC6 inhibitor) were administrated intraperitoneally 30 min prior to each sevoflurane exposure. After treatments, expression levels of synaptophysin and postsynaptic density 95 protein (PSD95) were quantified using Western blot, and synaptic ultrastructure was evaluated by transmission electron microscopy. Additional pups were raised until P49 to measure cognitive performance using the Morris water maze test. Our results demonstrated that multiple sevoflurane exposures enhanced HDAC6 expression and activity in hippocampi of the developing brain. Tubastatin A ameliorated sevoflurane-induced decreases in synaptophysin and PSD95 expression during development, as well as synaptic ultrastructural damage and cognitive deficits in adulthood. In conclusion, HDAC6 is involved in the developmental neurotoxicity caused by multiple sevoflurane exposures and its inhibition may prevent related damage.
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Affiliation(s)
- Guohui Li
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Jian'er Du
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Lai Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Xueyin Shi
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China.
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109
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Mastro KA, Flynn L, Preuster C, Summers-Gibson L, Stein MH. The Effects of Anesthesia on the Pediatric Developing Brain: Strategies to Reduce Anesthesia Use in Pediatric MRI and Nursing's Role in Driving Patient Safety. J Perianesth Nurs 2019; 34:900-910. [PMID: 31196698 DOI: 10.1016/j.jopan.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/04/2019] [Accepted: 02/15/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the physiological and biological principles of anesthesia for children; nonanesthesia practices; the state of the evidence of patient- and family-centered care strategies to reduce anesthesia use; and role of nursing in ensuring patient safety through reducing anesthesia use for pediatric magnetic resonance imaging (MRI). DESIGN Integrative literature review. METHODS Review and synthesis of experimental and nonexperimental literature. FINDINGS Anesthesia use in pediatric MRI: 20 studies met inclusion criteria. Physiological and biological side effects of anesthesia in children are substantial. Of significance is the developing research on the extent to which anesthesia affects the developing brain of children. Nonanesthesia in pediatric MRI: 16 studies met inclusion criteria. Common themes were noted between patient- and family-centered care strategies and reducing anesthesia use in children requiring MRI. CONCLUSIONS There are significant risks associated with anesthesia on the developing brain. Nurses play an important role in using patient-centered strategies to reduce pediatric anesthesia use and advocate for patient safety.
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110
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Abstract
Scientific studies in animal models have demonstrated the neurotoxic effects of anesthetic and sedative drugs on the developing brain. Human studies, however, have been limited and less conclusive. The implications for clinical care remain unclear, and there is a critical need for further research on anesthetic toxicity to ensure safe anesthesia practices for infants and children. The sixth PANDA Symposium organized a session on "Engaging Stakeholders to Support Research" to facilitate dialog around improving communication and collaboration among stakeholders and to promote coordinated research efforts. Key stakeholders include patients, families, clinicians, researchers, community organizations, and federal agencies. This article provides an overview of an online platform called the Family Talkboard, a novel method which is destined to enhance patient outreach, engagement, and quality improvement, as well as outcomes research.
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111
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Using Neuroimaging to Study the Effects of Pain, Analgesia, and Anesthesia on Brain Development. J Neurosurg Anesthesiol 2019; 31:119-121. [PMID: 30767934 DOI: 10.1097/ana.0000000000000549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Neuroimaging has been increasingly used as a modality to study the impact of pain, analgesia, and anesthetics on pediatric neurodevelopment. The sixth biennial Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) Symposium addressed the 2016 US Food and Drug Administration drug safety warning regarding the potential neurotoxic effects of commonly used anesthetic and sedative medications in children, and included a session discussing the use of various neuroimaging techniques, to detect structural, metabolic, and functional brain changes that can occur with exposure to pain and to anesthetic medications. The presenters concluded that advanced multimodal magnetic resonance imaging techniques are useful in detecting the aforementioned changes, which were found to be pain-specific and anesthetic agent-specific.
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112
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Waldschmidt B, Gordon N. Anesthesia for pediatric ophthalmologic surgery. J AAPOS 2019; 23:127-131. [PMID: 30995517 DOI: 10.1016/j.jaapos.2018.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 11/19/2022]
Abstract
This review presents updated recommendations, based on existing clinical research, for anesthetic management of strabismus surgery in children. In children, unlike adults, eye surgery nearly always requires general anesthesia, even for brief procedures. Recommendations for preoperative anxiolysis, fasting guidelines, and management of upper respiratory infections are discussed. Airway considerations and the oculocardiac reflex are highlighted. The prevention of postoperative complications, including those related to opioid prescription therapy, is also addressed. Finally, given the 2016 warning from the Food and Drug Administration about anesthesia neurotoxicity in children, we discuss recent studies on anesthetic neurotoxicity in children undergoing general anesthesia.
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Affiliation(s)
- Brian Waldschmidt
- Department of Anesthesiology, University of Vermont Medical Center, Burlington, Vermont.
| | - Noah Gordon
- Department of Anesthesiology, California Pacific Medical Center, Sutter Hospitals, Northern California Anesthesia Physicians, San Francisco, California
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113
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Mayo Anesthesia Safety in Kids continued: two new studies and a potential redirection of the field. Br J Anaesth 2019; 122:716-719. [DOI: 10.1016/j.bja.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/21/2022] Open
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114
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Zhang L, Xue Z, Liu Q, Liu Y, Xi S, Cheng Y, Li J, Yan J, Shen Y, Xiao C, Xie Z, Qiu Z, Jiang H. Disrupted folate metabolism with anesthesia leads to myelination deficits mediated by epigenetic regulation of ERMN. EBioMedicine 2019; 43:473-486. [PMID: 31060905 PMCID: PMC6562069 DOI: 10.1016/j.ebiom.2019.04.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022] Open
Abstract
Background Exposure to anesthetics during early life may impair cognitive functions. However, the underlying mechanisms remain largely unknown. We set out to determine effects of sevoflurane anesthesia on folate metabolism and myelination in young non-human primates, mice and children. Methods Young rhesus macaque and mice received 2.5 to 3% sevoflurane daily for three days. DNA and RNA sequencing and immunohistochemistry among others were used in the studies. We performed unbiased transcriptome profiling in prefrontal cortex of rhesus macaques and mice after the sevoflurane anesthesia. We constructed a brain blood barrier-crossing AAV-PHP.EB vector to harbor ERMN expression in rescue studies. We measured blood folate levels in children after anesthesia and surgery. Findings We found that thymidylate synthase (TYMS) gene was downregulated after the sevoflurane anesthesia in both rhesus macaque and mice. There was a reduction in blood folate levels in children after the anesthesia and surgery. Combined with transcriptome and genome-wide DNA methylation analysis, we identified that ERMN was the primary target of the disrupted folate metabolism. Myelination was compromised by the anesthesia in the young mice, which was rescued by systematic administration of folic acid or expression of ERMN in the brain through brain-specific delivery of the adeno-associated virus. Moreover, folic acid and expression of ERMN alleviated the cognitive impairment caused by the sevoflurane anesthesia in the mice. Interpretation General anesthesia leads to disrupted folate metabolism and subsequently defects in myelination in the developmental brain, and ERMN is the important target affected by the anesthesia via epigenetic mechanisms.
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Affiliation(s)
- Lei Zhang
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, PR China
| | - Zhenyu Xue
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, PR China
| | - Qidong Liu
- Anesthesia and Brain Research Institute, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Yunbo Liu
- The Institute of Laboratory Animal Science, CAMS & PUMC. Beijing, PR China
| | - Siwei Xi
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, PR China
| | - Yanyong Cheng
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, PR China
| | - Jingjie Li
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, PR China
| | - Jia Yan
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, PR China
| | - Yuan Shen
- Department of Psychiatry, Anesthesia and Brain Research Institute, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, PR China
| | - Chong Xiao
- The Institute of Laboratory Animal Science, CAMS & PUMC. Beijing, PR China
| | - Zhongcong Xie
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA.
| | - Zilong Qiu
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, PR China.
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, PR China.
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115
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Zhang L, Yan J, Liu Q, Xie Z, Jiang H. LncRNA Rik-203 contributes to anesthesia neurotoxicity via microRNA-101a-3p and GSK-3β-mediated neural differentiation. Sci Rep 2019; 9:6822. [PMID: 31048708 PMCID: PMC6497879 DOI: 10.1038/s41598-019-42991-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/09/2019] [Indexed: 12/30/2022] Open
Abstract
The mechanism of anesthesia neurotoxicity remains largely to be determined. The effects of long noncoding RNAs (LncRNAs) on neural differentiation and the underlying mechanisms are unknown. We thus identified LncRNA Rik-203 (C130071C03Rik) and studied its role on neural differentiation and its interactions with anesthetic sevoflurane, miRNA and GSK-3β. We found that levels of Rik-203 were higher in hippocampus than other tissues and increased during neural differentiation. Sevoflurane decreased the levels of Rik-203. Rik-203 knockdown reduced mRNA levels of Sox1 and Nestin, the markers of neural progenitor cells, and decreased the count of Sox1 positive cells. RNA-RNA pull-down showed that miR-101a-3p was highly bound to Rik-203. Finally, sevoflurane, knockdown of Rik-203, and miR-101a-3p overexpression all decreased GSK-3β levels. These data suggest that Rik-203 facilitates neural differentiation by inhibiting miR-101a-3p's ability to reduce GSK-3β levels and that LncRNAs would serve as the mechanism of the anesthesia neurotoxicity.
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Affiliation(s)
- Lei Zhang
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, P.R. China
| | - Jia Yan
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, P.R. China
| | - Qidong Liu
- Shanghai Tenth People's Hospital, Anesthesia and Brain Research Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Zhongcong Xie
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room, 4310, Charlestown, MA, USA.
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, P.R. China.
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116
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Neonatal exposure to the experimental environment or ketamine can induce long-term learning dysfunction or overmyelination in female but not male rats. Neuroreport 2019; 30:491-497. [PMID: 30920435 PMCID: PMC6493779 DOI: 10.1097/wnr.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ketamine can induce neurotoxicity after exposures to the developing brain. To investigate whether ketamine at subanesthetic dosage or its environmental condition can cause long-term cognitive dysfunction after multiple exposures in male or female neonatal rats, postnatal day 5 (P5)-day-old Sprague-Dawley rats were randomized into three groups: ketamine group, vehicle group, and control group (no disturbance). Learning and memory abilities from P60 to P65 and immunofluorescence tests for myelin basic protein (MBP) in gray matter on P65 were conducted. The results showed that in female rats, the path length on day 1 in ketamine group and on days 1 and 2 in vehicle group was longer than that in control (P<0.05), but there was no difference between ketamine and vehicle groups (P>0.05). The mean density of MBP in the medial prefrontal cortex (mPFC) was significantly increased in vehicle and ketamine groups compared with that in control (P<0.05), and there was a significant difference between vehicle and ketamine groups (P<0.05), but MBP density was not changed in CA1 or CA3 region (P>0.05). In male rats, there were no significant differences in path length among the groups, and the density of MBP in the mPFC and hippocampus in vehicle or ketamine group was not different from that in control (P>0.05). Pearson’s correlation analysis showed that there was a positive correlation between MBP density in the mPFC and path length in adult female rats (r=0.753, P<0.01). Overall, the results suggested that neonatal female rats exposed to multiple episodes of the experimental environment can develop learning dysfunction in adulthood, which may result from overmyelination in the mPFC, but male rats were not affected. Ketamine could increase myelination in the mPFC in female rats, but it did not induce learning dysfunction in adulthood; therefore, ketamine may be a safe drug for pediatric anesthesia.
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Ropers FG, Pham ENB, Kant SG, Rotteveel LJC, Rings EHHM, Verbist BM, Dekkers OM. Assessment of the Clinical Benefit of Imaging in Children With Unilateral Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2019; 145:431-443. [PMID: 30946449 PMCID: PMC6537917 DOI: 10.1001/jamaoto.2019.0121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/21/2019] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Imaging used to determine the cause of unilateral sensorineural hearing loss (USNHL) in children is often justified by the high likelihood of detecting abnormalities, which implies that these abnormalities are associated with hearing loss and that imaging has a positive contribution to patient outcome or well-being by providing information on the prognosis, hereditary factors, or cause of hearing loss. OBJECTIVES To evaluate the diagnostic yield of computed tomography (CT) and magnetic resonance imaging (MRI) in children with isolated unexplained USNHL and investigate the clinical relevance of these findings. EVIDENCE REVIEW Cochrane Library, Embase, PubMed, and Web of Science databases were searched for articles published from 1978 to 2017 on studies of children with USNHL who underwent CT and/or MRI of the temporal bone. Two authors (F.G.R. and E.N.B.P.) independently extracted information on population characteristics, imaging modality, and the prevalence of abnormalities and assessed the studies for risk of bias. Eligibility criteria included studies with 20 or more patients with USNHL who had CT and/or MRI scans, a population younger than 18 years, and those published in English. MAIN OUTCOMES AND MEASURES The pooled prevalence with 95% CI of inner ear abnormalities grouped according to finding and imaging modality. FINDINGS Of 1562 studies, 18 were included with a total of 1504 participants included in the analysis. Fifteen studies were consecutive case studies and 3 were retrospective cohort studies. The pooled diagnostic yield for pathophysiologic relevant findings in patients with unexplained USNHL was 37% for CT (95% CI, 25%-48%) and 35% for MRI (95% CI, 22%-49%). Cochleovestibular abnormalities were found with a pooled frequency of 19% for CT (95% CI, 14%-25%) and 16% for MRI (95% CI, 7%-25%). Cochlear nerve deficiency and associated cochlear aperture stenosis had a pooled frequency of 16% for MRI (95% CI, 3%-29%) and 44% for CT (95% CI, 36%-53%), respectively. Enlarged vestibular aqueduct (EVA) was detected with a pooled frequency of 7% for CT and 12% for MRI in children with USNHL. CONCLUSIONS AND RELEVANCE Imaging provided insight into the cause of hearing loss in a pooled frequency of about 35% to 37% in children with isolated unexplained USNHL. However, none of these findings had therapeutic consequences, and imaging provided information on prognosis and hereditary factors only in a small proportion of children, namely those with EVA. Thus, there is currently no convincing evidence supporting a strong recommendation for imaging in children who present with USNHL. The advantages of imaging should be carefully balanced against the drawbacks during shared decision making.
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Affiliation(s)
- Fabienne G. Ropers
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Eveline N. B. Pham
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Sarina G. Kant
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Edmond H. H. M. Rings
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Berit M. Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Olaf M. Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Section Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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Zaccariello MJ, Frank RD, Lee M, Kirsch AC, Schroeder DR, Hanson AC, Schulte PJ, Wilder RT, Sprung J, Katusic SK, Flick RP, Warner DO. Patterns of neuropsychological changes after general anaesthesia in young children: secondary analysis of the Mayo Anesthesia Safety in Kids study. Br J Anaesth 2019; 122:671-681. [PMID: 30982593 DOI: 10.1016/j.bja.2019.01.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/04/2019] [Accepted: 01/18/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We hypothesised that exposure to multiple, but not single, procedures requiring general anaesthesia before age 3 yr is associated with a specific pattern of deficits in processing speed and fine motor skills. METHODS A secondary analysis (using factor and cluster analyses) of data from the Mayo Anesthesia Safety in Kids study was conducted, in which unexposed, singly exposed, and multiply exposed children born in Olmsted County, MN, USA from 1994 to 2007 were sampled using a propensity-guided approach and underwent neuropsychological testing at ages 8-12 or 15-20 yr. RESULTS In the factor analysis, the data were well fit to a five factor model. For subjects multiply (but not singly) exposed to anaesthesia, a factor reflecting motor skills, visual-motor integration, and processing speed was significantly lower [standardised difference of -0.35 (95% confidence interval {CI} -0.57 to -0.13)] compared with unexposed subjects. No other factor was associated with exposure. Three groups were identified in the cluster analysis, with 106 subjects (10.6%) in Cluster A (lowest performance in most tests), 557 (55.9%) in Cluster B, and 334 (33.5%) in Cluster C (highest performance in most tests). The odds of multiply exposed children belonging to Cluster A was 2.83 (95% CI: 1.49-5.35; P=0.001) compared with belonging to Cluster B; there was no other significant association between exposure status and cluster membership. CONCLUSIONS Multiple, but not single, exposures to procedures requiring general anaesthesia before age 3 yr are associated with a specific pattern of deficits in neuropsychological tests. Factors predicting which children develop the most pronounced deficits remain unknown.
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Affiliation(s)
| | | | - Minji Lee
- Department of Health Sciences Research
| | | | | | | | | | - Robert T Wilder
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Randall P Flick
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Gluncic V, Moric M, Chu Y, Hanko V, Li J, Lukić IK, Lukić A, Edassery SL, Kroin JS, Persons AL, Perry P, Kelly L, Shiveley TJ, Nice K, Napier CT, Kordower JH, Tuman KJ. In utero Exposure to Anesthetics Alters Neuronal Migration Pattern in Developing Cerebral Cortex and Causes Postnatal Behavioral Deficits in Rats. Cereb Cortex 2019; 29:5285-5301. [DOI: 10.1093/cercor/bhz065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract
During fetal development, cerebral cortical neurons are generated in the proliferative zone along the ventricles and then migrate to their final positions. To examine the impact of in utero exposure to anesthetics on neuronal migration, we injected pregnant rats with bromodeoxyuridine to label fetal neurons generated at embryonic Day (E) 17 and then randomized these rats to 9 different groups receiving 3 different means of anesthesia (oxygen/control, propofol, isoflurane) for 3 exposure durations (20, 50, 120 min). Histological analysis of brains from 54 pups revealed that significant number of neurons in anesthetized animals failed to acquire their correct cortical position and remained dispersed within inappropriate cortical layers and/or adjacent white matter. Behavioral testing of 86 littermates pointed to abnormalities that correspond to the aberrations in the brain areas that are specifically developing during the E17. In the second set of experiments, fetal brains exposed to isoflurane at E16 had diminished expression of the reelin and glutamic acid decarboxylase 67, proteins critical for neuronal migration. Together, these results call for cautious use of anesthetics during the neuronal migration period in pregnancy and more comprehensive investigation of neurodevelopmental consequences for the fetus and possible consequences later in life.
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Affiliation(s)
- V Gluncic
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago IL, USA
| | - M Moric
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - Y Chu
- Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - V Hanko
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - J Li
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - I K Lukić
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - A Lukić
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - S L Edassery
- Department of Pharmacology, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - J S Kroin
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - A L Persons
- Department of Pharmacology, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
- The Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL, USA
| | - P Perry
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - L Kelly
- Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - T J Shiveley
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
| | - K Nice
- Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - C T Napier
- Department of Pharmacology, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
- The Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL, USA
- Department of Psychiatry, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - J H Kordower
- Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - K J Tuman
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA
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Sinner B, Steiner J, Malsy M, Graf BM, Bundscherer A. The positive allosteric modulation of GABA A receptors mRNA in immature hippocampal rat neurons by midazolam affects receptor expression and induces apoptosis. Int J Neurosci 2019; 129:986-994. [PMID: 30957600 DOI: 10.1080/00207454.2019.1604524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Numerous experimental studies show that anesthetics are potentially toxic to the immature brain. Even though benzodiazepines are widely used in pediatric anesthesia and intensive care medicine, only a few studies examine the effects of these drugs on immature neurons. Methods: Hippocampal neuronal cell cultures of embryonic Wistar rats (15 days in culture) were incubated with midazolam 100 or 300 nM for either 30 min or 4 h. The time course of the mRNA expression of the glutamate receptors subunits NR1, NR2A and NR2B of the NMDA receptor, the GluA-1 and A-2 subunits of the AMPA receptor as well as the alpha 1 subunit of the GABAA receptor were examined by PCR. Apoptosis was detected using Western blot analysis for BAX, Bcl-2 and Caspase-3. Results: Midazolam at 100 and 300 nM applied for 30 min and 100 nM for 4 h affected glutamate receptor and GABAA receptor subunit expression. However, these effects were reversible within 72 h following washout. When 300 nM midazolam was applied for 4 h a significant increase in the NR 1 and NR 2A mRNA subunit expression could be detected. The increase in NR 2B receptor subunit expression as well as the GluA1 subunit expression was not reversible within 72 h following washout. This increase in mRNA glutamate receptor subunit expression was associated with a significant increase in neuronal apoptosis. Conclusion: In immature neurons midazolam altered GABA and glutamate mRNA receptor subunit expression. Prolonged increase in midazolam-induced glutamate receptor expression was associated with apoptosis.
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Affiliation(s)
- Barbara Sinner
- Department of Anesthesiology, University Hospital Regensburg , Regensburg , Germany
| | - Julia Steiner
- Department of Anesthesiology, University Hospital Regensburg , Regensburg , Germany
| | - Manuela Malsy
- Department of Anesthesiology, University Hospital Regensburg , Regensburg , Germany
| | - Bernhard M Graf
- Department of Anesthesiology, University Hospital Regensburg , Regensburg , Germany
| | - Anika Bundscherer
- Department of Anesthesiology, University Hospital Regensburg , Regensburg , Germany
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Rosado-Mendez IM, Noguchi KK, Castañeda-Martinez L, Kirvassilis G, Wang SH, Manzella F, Swiney BS, Masuoka K, Capuano S, Brunner KG, Crosno K, Guerrero QW, Whitson H, Brambrink A, Simmons HS, Mejia AF, Zagzebski JA, Hall TJ, Ikonomidou C. Quantitative ultrasound and apoptotic death in the neonatal primate brain. Neurobiol Dis 2019; 127:554-562. [PMID: 30951850 DOI: 10.1016/j.nbd.2019.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/24/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022] Open
Abstract
Apoptosis is triggered in the developing mammalian brain by sedative, anesthetic or antiepileptic drugs during late gestation and early life. Whether human children are vulnerable to this toxicity mechanism remains unknown, as there are no imaging techniques to capture it. Apoptosis is characterized by distinct structural features, which affect the way damaged tissue scatters ultrasound compared to healthy tissue. We evaluated whether apoptosis, triggered by the anesthetic sevoflurane in the brains of neonatal rhesus macaques, can be detected using quantitative ultrasound (QUS). Neonatal (n = 15) rhesus macaques underwent 5 h of sevoflurane anesthesia. QUS images were obtained through the sagittal suture at 0.5 and 6 h. Brains were collected at 8 h and examined immunohistochemically to analyze apoptotic neuronal and oligodendroglial death. Significant apoptosis was detected in white and gray matter throughout the brain, including the thalamus. We measured a change in the effective scatterer size (ESS), a QUS biomarker derived from ultrasound echo signals obtained with clinical scanners, after sevoflurane-anesthesia in the thalamus. Although initial inclusion of all measurements did not reveal a significant correlation, when outliers were excluded, the change in the ESS between the pre- and post-anesthesia measurements correlated strongly and proportionally with the severity of apoptotic death. We report for the first time in vivo changes in QUS parameters, which may reflect severity of apoptosis in the brains of infant nonhuman primates. These findings suggest that QUS may enable in vivo studies of apoptosis in the brains of human infants following exposure to anesthetics, antiepileptics and other brain injury mechanisms.
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Affiliation(s)
- Ivan M Rosado-Mendez
- Instituto de Física, Universidad Nacional Autónoma de México, CDMX, Mexico; Department of Medical Physics, University of Wisconsin, School of Medicine, Madison, WI, USA
| | - Kevin K Noguchi
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | | | - George Kirvassilis
- Department of Anesthesiology, University of Wisconsin, School of Medicine, Madison, WI, USA
| | - Sophie H Wang
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Francesca Manzella
- Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Brant S Swiney
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Kobe Masuoka
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Saverio Capuano
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kevin G Brunner
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kristin Crosno
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Quinton W Guerrero
- Department of Medical Physics, University of Wisconsin, School of Medicine, Madison, WI, USA
| | - Hayley Whitson
- Department of Medical Physics, University of Wisconsin, School of Medicine, Madison, WI, USA
| | - Ansgar Brambrink
- Department of Anesthesiology, Columbia University, New York, USA
| | | | - Andres F Mejia
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - James A Zagzebski
- Department of Medical Physics, University of Wisconsin, School of Medicine, Madison, WI, USA
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, School of Medicine, Madison, WI, USA
| | - Chrysanthy Ikonomidou
- Department of Neurology, University of Wisconsin, School of Medicine, Madison, WI, USA.
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Abstract
BACKGROUND Early-onset scoliosis is a spine deformity that presents before the age of 3 years. When compared with age-matched controls, children with the condition are known to be at risk for significant morbidity and mortality. Although many works support the use of casting for this condition, the key technical factors to optimize the outcomes of casting are not clear. This work was designed to evaluate the role of frequency of radiographic imaging and over the shoulder straps in the outcomes of casting. METHODS Two surgeons at 2 centers followed nearly identical protocols for applying casts for early-onset scoliosis. At center A, the surgeon hoped to improve outcomes by obtaining radiographs after each cast and by reinforcing the cast with shoulder straps. At center B, the surgeon did not use shoulder straps and limited radiographs to once every 6 months. Children were included if they were 3 years or below of age and had a curve of ≥50 degrees at the time of the first cast and had a minimum of 3 years of follow-up. Center was used as a variable in a multivariable regression that also included: age at first cast, initial curve magnitude, and presence of a syrinx or genetic syndrome with the outcome of curve resolution. RESULTS There were 40 children at center A, 9 of whom experienced resolution of their scoliosis. There were 36 children at center B, and 11 demonstrated scoliosis resolution. At center A, 2 of 10 children with a syrinx or genetic syndrome demonstrated curve resolution while 7 of 30 without these comorbidities did. At center B 3 of 10 children with a syrinx or genetic syndrome had curve resolution while 8 of 26 children without these comorbidities did. CONCLUSIONS The children in group A demonstrated results very similar to the children of group B. Thus, the extra burden of shoulder straps and frequent radiographs are unnecessary. LEVEL OF EVIDENCE Level III.
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Abstract
PURPOSE OF REVIEW Compelling evidence in animal models that, under some conditions, general anesthetics and sedatives produce changes in the brain and persistent impairments in learning, memory, and behavior. The present review summarizes recent clinical studies investigating whether the use of these agents in children causes similar neurotoxicities. RECENT FINDINGS Although the results of retrospective studies are somewhat mixed, multiple exposures to general anesthesia were generally found to confer greater risk than single exposures with regard to learning disability, attention deficit hyperactivity disorder, school readiness, and academic achievement. Recent clinical studies, including a large randomized controlled trial, are consistent in confirming that a single exposure in infancy to general anesthesia lasting less than 1 h is not associated with neurodevelopmental impairments in later childhood. These studies do not, however, clarify the potential impacts of longer exposures or multiple exposures. SUMMARY Given that approximately half of the anesthetic exposures in young US children are 1 h or less in duration, the results of the recent clinical studies are reassuring. Because of the clinical necessity of administering general anesthetics and sedatives for longer periods for many surgical, procedural, or diagnostic purposes, the identification of adjuvants that prevent or reduce the potential neurotoxicity of these agents is an area of active research.
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Limb Remote Ischemic Preconditioning Reduces Repeated Ketamine Exposure-Induced Adverse Effects in the Developing Brain of Rats. J Mol Neurosci 2019; 68:58-65. [DOI: 10.1007/s12031-019-01282-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/18/2019] [Indexed: 11/26/2022]
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Liu B, Ou G, Chen Y, Zhang J. Inhibition of protein tyrosine phosphatase 1B protects against sevoflurane-induced neurotoxicity mediated by ER stress in developing brain. Brain Res Bull 2019; 146:28-39. [DOI: 10.1016/j.brainresbull.2018.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/14/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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Maloney SE, Yuede CM, Creeley CE, Williams SL, Huffman JN, Taylor GT, Noguchi KN, Wozniak DF. Repeated neonatal isoflurane exposures in the mouse induce apoptotic degenerative changes in the brain and relatively mild long-term behavioral deficits. Sci Rep 2019; 9:2779. [PMID: 30808927 PMCID: PMC6391407 DOI: 10.1038/s41598-019-39174-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/18/2019] [Indexed: 11/22/2022] Open
Abstract
Epidemiological studies suggest exposures to anesthetic agents and/or sedative drugs (AASDs) in children under three years old, or pregnant women during the third trimester, may adversely affect brain development. Evidence suggests lengthy or repeated AASD exposures are associated with increased risk of neurobehavioral deficits. Animal models have been valuable in determining the type of acute damage in the developing brain induced by AASD exposures, as well as in elucidating long-term functional consequences. Few studies examining very early exposure to AASDs suggest this may be a critical period for inducing long-term functional consequences, but the impact of repeated exposures at these ages has not yet been assessed. To address this, we exposed mouse pups to a prototypical general anesthetic, isoflurane (ISO, 1.5% for 3 hr), at three early postnatal ages (P3, P5 and P7). We quantified the acute neuroapoptotic response to a single versus repeated exposure, and found age- and brain region-specific effects. We also found that repeated early exposures to ISO induced subtle, sex-specific disruptions to activity levels, motor coordination, anxiety-related behavior and social preference. Our findings provide evidence that repeated ISO exposures may induce behavioral disturbances that are subtle in nature following early repeated exposures to a single AASD.
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Affiliation(s)
- Susan E Maloney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Psychology, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
- Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA
| | - Carla M Yuede
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Catherine E Creeley
- Department of Psychology, State University of New York at Fredonia, Fredonia, NY, 14063, USA
| | - Sasha L Williams
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jacob N Huffman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - George T Taylor
- Department of Psychology, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Kevin N Noguchi
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA
| | - David F Wozniak
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine, St. Louis, MO, USA.
- Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA.
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McCann ME, de Graaff JC, Dorris L, Disma N, Withington D, Bell G, Grobler A, Stargatt R, Hunt RW, Sheppard SJ, Marmor J, Giribaldi G, Bellinger DC, Hartmann PL, Hardy P, Frawley G, Izzo F, von Ungern Sternberg BS, Lynn A, Wilton N, Mueller M, Polaner DM, Absalom AR, Szmuk P, Morton N, Berde C, Soriano S, Davidson AJ. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet 2019; 393:664-677. [PMID: 30782342 PMCID: PMC6500739 DOI: 10.1016/s0140-6736(18)32485-1] [Citation(s) in RCA: 386] [Impact Index Per Article: 77.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes. METHODS In this international, assessor-masked, equivalence, randomised, controlled trial conducted at 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand, we recruited infants of less than 60 weeks' postmenstrual age who were born at more than 26 weeks' gestation and were undergoing inguinal herniorrhaphy, without previous exposure to general anaesthesia or risk factors for neurological injury. Patients were randomly assigned (1:1) by use of a web-based randomisation service to receive either awake-regional anaesthetic or sevoflurane-based general anaesthetic. Anaesthetists were aware of group allocation, but individuals administering the neurodevelopmental assessments were not. Parents were informed of their infants group allocation upon request, but were told to mask this information from assessors. The primary outcome measure was full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III), at 5 years of age. The primary analysis was done on a per-protocol basis, adjusted for gestational age at birth and country, with multiple imputation used to account for missing data. An intention-to-treat analysis was also done. A difference in means of 5 points was predefined as the clinical equivalence margin. This completed trial is registered with ANZCTR, number ACTRN12606000441516, and ClinicalTrials.gov, number NCT00756600. FINDINGS Between Feb 9, 2007, and Jan 31, 2013, 4023 infants were screened and 722 were randomly allocated: 363 (50%) to the awake-regional anaesthesia group and 359 (50%) to the general anaesthesia group. There were 74 protocol violations in the awake-regional anaesthesia group and two in the general anaesthesia group. Primary outcome data for the per-protocol analysis were obtained from 205 children in the awake-regional anaesthesia group and 242 in the general anaesthesia group. The median duration of general anaesthesia was 54 min (IQR 41-70). The mean FSIQ score was 99·08 (SD 18·35) in the awake-regional anaesthesia group and 98·97 (19·66) in the general anaesthesia group, with a difference in means (awake-regional anaesthesia minus general anaesthesia) of 0·23 (95% CI -2·59 to 3·06), providing strong evidence of equivalence. The results of the intention-to-treat analysis were similar to those of the per-protocol analysis. INTERPRETATION Slightly less than 1 h of general anaesthesia in early infancy does not alter neurodevelopmental outcome at age 5 years compared with awake-regional anaesthesia in a predominantly male study population. FUNDING US National Institutes of Health, US Food and Drug Administration, Thrasher Research Fund, Australian National Health and Medical Research Council, Health Technologies Assessment-National Institute for Health Research (UK), Australian and New Zealand College of Anaesthetists, Murdoch Children's Research Institute, Canadian Institutes of Health Research, Canadian Anesthesiologists Society, Pfizer Canada, Italian Ministry of Health, Fonds NutsOhra, UK Clinical Research Network, Perth Children's Hospital Foundation, the Stan Perron Charitable Trust, and the Callahan Estate.
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Affiliation(s)
- Mary Ellen McCann
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Jurgen C de Graaff
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, Netherlands; Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Liam Dorris
- Paediatric Neurosciences, Royal Hospital for Children, Glasgow, Scotland, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola Disma
- Department of Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Davinia Withington
- Department of Anaesthesia, Montreal Children's Hospital, Montreal, QC, Canada; Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Graham Bell
- Department of Anaesthesia, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Anneke Grobler
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Robyn Stargatt
- Child Neuropsychology, Murdoch Children's Research Institute, Parkville, VIC, Australia; School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia
| | - Rodney W Hunt
- Neonatal Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Suzette J Sheppard
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jacki Marmor
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Gaia Giribaldi
- Department of Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Penelope L Hartmann
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Pollyanna Hardy
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Geoff Frawley
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Francesca Izzo
- Department of Anaesthesiology and Paediatric Intensive Care, Ospedale Pediatrico Vittore Buzzi, Milan, Italy
| | - Britta S von Ungern Sternberg
- Medical School, The University of Western Australia, Perth, WA, Australia; Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia; Telethon Kid's Institute, Perth, WA, Australia
| | - Anne Lynn
- Department of Anesthesiology and Pain Medicine, and Pediatrics University of Washington, Seattle, WA, USA; Department of Anaesthesia and Pain Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Niall Wilton
- Department of Paediatric Anaesthesia and Operating Rooms, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Martin Mueller
- Department of Anaesthesia, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - David M Polaner
- Department of Anaesthesiology, Children's Hospital Colorado, Denver, CO, USA; Department of Anaesthesiology, University of Colorado, Denver, CO, USA
| | - Anthony R Absalom
- Department of Anaesthesiology, University Medical Centre Groningen, Groningen University, Groningen, Netherlands
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Medical Centre Dallas, Dallas, TX, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Neil Morton
- Department of Anaesthesia, Royal Hospital for Children, Glasgow, Scotland, UK; Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow, UK
| | - Charles Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sulpicio Soriano
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Andrew J Davidson
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, VIC, Australia.
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128
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Baky FJ, Milbrandt TA, Flick R, Larson AN. Cumulative Anesthesia Exposure in Patients Treated for Early-Onset Scoliosis. Spine Deform 2019; 6:781-786. [PMID: 30348358 DOI: 10.1016/j.jspd.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/02/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early-onset scoliosis (EOS) is a potentially life-threatening condition that requires early intervention to prevent severe deformity and pulmonary compromise. Observational studies have demonstrated that children receiving multiple procedures requiring general anesthesia are at a higher risk for adverse neurocognitive outcomes. We sought to characterize anesthetic exposure in EOS patients and to determine risk factors for increased exposure. We hypothesized that patients treated for EOS were at risk of receiving large amounts of cumulative anesthesia in childhood because of the need for early intervention to preserve pulmonary function. We sought to determine which factors impacted the amount of anesthesia patients received over the course of treatment. METHODS Records of all EOS patients treated at a tertiary referral center from 2000 to 2014 were reviewed. Patients with a minimum two-year follow-up, under age 10 at diagnosis, were included. Anesthesia was recorded in three categories: 1) orthopedic surgeries; 2) nonorthopedic surgeries; and 3) imaging/associated procedures. Diagnoses included congenital, idiopathic, neuromuscular, and syndromic scoliosis. Treatment groups were: observation, bracing, Mehta casting, growing spine, or fusion. RESULTS Mean cumulative anesthesia time was 1606 minutes. Patients with neuromuscular (mean 2132 minutes, p = .006) or congenital scoliosis (1875 minutes, p < .001) received more anesthesia than those with idiopathic scoliosis (754 minutes). Patients treated by fusion (2036 minutes, p < .001) or growing spine (2855 minutes, p < .001) received more anesthesia than those treated by bracing. CONCLUSIONS Disease severity, non-idiopathic diagnoses, and longer length of follow-up were associated with increased anesthesia. Patients who presented at earlier ages, and those treated by Mehta casting, were more likely to exceed three hours of anesthesia prior to age 3. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Fady J Baky
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Todd A Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Randall Flick
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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129
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Performance on the Operant Test Battery in young children exposed to procedures requiring general anaesthesia: the MASK study. Br J Anaesth 2019; 122:470-479. [PMID: 30857603 DOI: 10.1016/j.bja.2018.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/03/2018] [Accepted: 12/28/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND It is not known whether the neurotoxicity produced by anaesthetics administered to young animals can also occur in children. Exposure of infant macaques to ketamine impairs performance in selected domains of the Operant Test Battery (OTB), which can also be administered to children. This study determined whether a similar pattern of results on the OTB is found in children exposed to procedures requiring general anaesthesia before age 3 yr. METHODS We analysed data from the Mayo Anesthesia Safety in Kids (MASK) study, in which unexposed, singly-exposed, and multiply-exposed children born in Olmsted County, MN, USA, from 1994 to 2007 were sampled using a propensity-guided approach and prospectively underwent OTB testing at ages 8-12 or 15-20 yr, using five tasks that generated 15 OTB test scores. RESULTS In primary analysis, none of the OTB test scores depended upon anaesthesia exposure status when corrected for multiple comparisons. Cluster analysis identified four clusters of subjects, with cluster membership determined by relative performance on the OTB tasks. There was no evidence of association between exposure status and cluster membership. Exploratory factor analysis showed that the OTB scores loaded onto four factors. The score for one factor was significantly less in multiply-exposed children (mean standardised difference -0.28 [95% confidence interval, -0.55 to -0.01; P=0.04]), but significance did not survive a sensitivity analysis accounting for outlying values. CONCLUSIONS These findings provide little evidence to support the hypothesis that children exposed to procedures requiring anaesthesia show deficits on OTB tasks that are similar to those observed in non-human primates.
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130
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Yu D, Xiao R, Huang J, Cai Y, Bao X, Jing S, Du Z, Yang T, Fan X. Neonatal exposure to propofol affects interneuron development in the piriform cortex and causes neurobehavioral deficits in adult mice. Psychopharmacology (Berl) 2019; 236:657-670. [PMID: 30415279 DOI: 10.1007/s00213-018-5092-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/25/2018] [Indexed: 11/24/2022]
Abstract
RATIONALE Animal studies have shown that early postnatal propofol administration is involved in neurobehavioral alterations in adults. However, the underlying mechanism is not clear. METHODS We used c-Fos immunohistochemistry to identify activated neurons in brain regions of neonatal mice under propofol exposure and performed behavioral tests to observe the long-term consequences. RESULTS Exposure to propofol (30g or 60 mg/kg) on P7 produced significant c-Fos expression in the deep layers of the piriform cortex on P8. Double immunofluorescence of c-Fos with interneuron markers in the piriform cortex revealed that c-Fos was specifically induced in calbindin (CB)-positive interneurons. Repeated propofol exposure from P7 to P9 induced behavioral deficits in adult mice, such as olfactory function deficit in a buried food test, decreased sociability in a three-chambered choice task, and impaired recognitive ability of learning and memory in novel object recognition tests. However, locomotor activity in the open-field test was not generally affected. Propofol treatment also significantly decreased the number of CB-positive interneurons in the piriform cortex of mice on P21 and adulthood. CONCLUSIONS These results suggest that CB-positive interneurons in the piriform cortex are vulnerable to propofol exposure during the neonatal period, and these neurons are involved in the damage effects of propofol on behavior changes. These data provide a new target of propofol neurotoxicity and may elucidate the mechanism of neurobehavioral deficits in adulthood.
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Affiliation(s)
- Dan Yu
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.,Department of Anesthesiology, Wuhan No.4 Hospital, Wuhan Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430033, People's Republic of China
| | - Rui Xiao
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.,Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Jing Huang
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Yulong Cai
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Xiaohang Bao
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.,Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Sheng Jing
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Zhiyong Du
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | - Tiande Yang
- Department of Anesthesiology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.
| | - Xiaotang Fan
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing, 400038, People's Republic of China.
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131
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Paulson A, Zigler CK, Houtrow A, Pruitt D. Botulinum Toxin: Techniques Within Pediatric Physiatry. PM R 2019; 11:38-44. [DOI: 10.1016/j.pmrj.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Andrea Paulson
- Department of Pediatrics; University of Cincinnati College of Medicine; Cincinnati OH 45267; Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Christina K. Zigler
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh; Pittsburgh PA
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh; Pittsburgh PA
| | - David Pruitt
- Department of Pediatrics; University of Cincinnati College of Medicine; Cincinnati OH; Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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132
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Striano BM, Refakis C, Garg S, El-Hawary R, Pahys JM, Vitale M, Campbell RM, Flynn JM, Cahill PJ. How Often Do You Lengthen? A Physician Survey on Lengthening Practice for Prosthetic Rib Devices. Spine Deform 2019; 6:473-477. [PMID: 29886922 DOI: 10.1016/j.jspd.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/08/2017] [Accepted: 12/16/2017] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Physician survey. OBJECTIVES To identify physician practice patterns in use of prosthetic rib devices. BACKGROUND Management of scoliosis with prosthetic ribs involves repeated expansions. Despite this, there is a paucity of literature on expansion practice. We believe that despite minimal literature, there exist surgeon practice patterns. METHODS Thirty-seven surgeons from the Children's Spine Study Group, with prosthetic rib experience, were anonymously surveyed about their expansion practice. RESULTS There was strong consensus that elapsed time since previous surgery was the most important factor in choosing lengthening intervals, with 94.5% of responders agreeing. Surgeons indicated that they often apply a standard expansion interval. 97.3% reported using one in >25% of cases, with 70.3% using a standard interval in >80% of cases. Six months was the most commonly reported elapsed time interval, with 78.4% of responders in agreement. There was also consensus on non-time factors. Patient maturity was cited a major factor in choosing lengthening interval in >80% of cases by 59.5% of responders. Patient age was frequently cited as a factor, with 73% of surgeons using it in >25% of cases. Additionally, there was consensus on factors that were not utilized. More than three-fourths (75.7%) stated that they use patients' bone quality <25% of the time. Similarly, 70.3% used resistance encountered in the last lengthening <25% of the time, with 13.5% never considering. CONCLUSION Despite the lack of evidence-based guidelines regarding lengthening practice for prosthetic ribs, there is some consensus on the factors used to choose an appropriate expansion interval. The greatest consensus surrounded the use of a standard six-month elapsed time interval between expansions. From these data, we conclude that specialists have reached relative consensus on factors important for choosing an appropriate expansion interval. We believe these data are an important step toward developing best practice guidelines and identifying areas of equipoise amenable for future research. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Brendan M Striano
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Christian Refakis
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sumeet Garg
- University of Colorado, Boulder, CO 80309, USA
| | - Ron El-Hawary
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Joshua M Pahys
- Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - Michael Vitale
- Columbia University Medical Center, 630 W 168th St, New York, NY 10032, USA
| | - Robert M Campbell
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - John M Flynn
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Patrick J Cahill
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
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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. Anesthesiology 2019; 129:89-105. [PMID: 29672337 DOI: 10.1097/aln.0000000000002232] [Citation(s) in RCA: 316] [Impact Index Per Article: 63.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Few studies of how exposure of children to anesthesia may affect neurodevelopment employ comprehensive neuropsychological assessments. This study tested the hypothesis that exposure to multiple, but not single, procedures requiring anesthesia before age 3 yr is associated with adverse neurodevelopmental outcomes. METHODS Unexposed, singly exposed, and multiply exposed children born in Olmsted County, Minnesota, from 1994 to 2007 were sampled using a propensity-guided approach and underwent neuropsychological testing at ages 8 to 12 or 15 to 20 yr. The primary outcome was the Full-Scale intelligence quotient standard score of the Wechsler Abbreviated Scale of Intelligence. Secondary outcomes included individual domains from a comprehensive neuropsychological assessment and parent reports. RESULTS In total, 997 children completed testing (411, 380, and 206 unexposed, singly exposed, and multiply exposed, respectively). The primary outcome of intelligence quotient did not differ significantly according to exposure status; multiply exposed and singly exposed children scoring 1.3 points (95% CI, -3.8 to 1.2; P = 0.32) and 0.5 points (95% CI, -2.8 to 1.9; P = 0.70) lower than unexposed children, respectively. For secondary outcomes, processing speed and fine motor abilities were decreased in multiply but not singly exposed children; other domains did not differ. The parents of multiply exposed children reported increased problems related to executive function, behavior, and reading. CONCLUSIONS Anesthesia exposure before age 3 yr was not associated with deficits in the primary outcome of general intelligence. Although secondary outcomes must be interpreted cautiously, they suggest the hypothesis that multiple, but not single, exposures are associated with a pattern of changes in specific neuropsychological domains that is associated with behavioral and learning difficulties.
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134
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O'Leary JD, Warner DO. What do recent human studies tell us about the association between anaesthesia in young children and neurodevelopmental outcomes? Br J Anaesth 2019; 119:458-464. [PMID: 28969310 DOI: 10.1093/bja/aex141] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Anaesthetic and sedative drugs transiently disrupt normal neural activity to facilitate healthcare procedures in children, but they can also cause long-term brain injury in experimental animal models. The US Food and Drug Administration (FDA) has recently advised that repeated or lengthy exposures to anaesthetic and sedative drugs prior to 3 yr of age have the potential to harm the development of children's brains and added warnings to these drug labels. Paediatric anaesthesia toxicity could represent a significant public health issue, and concern about this potential injury in children has become an important issue for families, paediatric clinicians and healthcare regulators. Since late 2015, important new data from five major clinical studies have been published. This narrative review aims to provide a brief overview of the preclinical and clinical literature, including a comprehensive review of these recent additions to the human literature. We integrate these new data with prior studies to provide further insights into how these clinical findings can be applied to children.
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Affiliation(s)
- J D O'Leary
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.,Department of Anaesthesia, University of Toronto, 12th Floor, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada
| | - D O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, 200?1ST ST SW, Rochester, MN 55905, USA
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135
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Alvarado MC, Murphy KL, Baxter MG. Visual recognition memory is impaired in rhesus monkeys repeatedly exposed to sevoflurane in infancy. Br J Anaesth 2019; 119:517-523. [PMID: 28575197 DOI: 10.1093/bja/aew473] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Experimental studies in animals have shown that exposure to general anaesthesia in infancy can cause loss of cells in the central nervous system and long-term impairments in neurocognitive function. Some human epidemiological studies have shown increased risk of learning disability after repeated anaesthesia exposure in early childhood. Thus, we investigated in a highly translational rhesus monkey model, whether repeated exposure in infancy to the inhalation anaesthetic sevoflurane is associated with impaired visual recognition memory during the first two yr of life. Methods Rhesus monkeys of both sexes were exposed to sevoflurane inhalation anaesthesia on approximately postnatal day 7 and then again 14 and 28 days later, for four h each time. Visual recognition memory was tested using the visual paired comparison task, which measures memory by assessing preference for looking at a new image over a previously-viewed image. Monkeys were tested at 6-10 months of age, again at 12-18 months of age, and again at 24-30 months of age. Results No memory impairment was detected at 6-10 months old, but significant impairment (reduced time looking at the novel image) was observed at 12-18 and 24-30 months old. Conclusions Repeated exposure of infant rhesus monkeys to sevoflurane results in visual recognition memory impairment that emerges after the first yr of life. This is consistent with epidemiological studies that show increased risk of learning disability after repeated exposure to anaesthesia in infancy/early childhood. Moreover, these deficits may emerge at later developmental stages, even when memory performance is unaffected earlier in development.
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Affiliation(s)
- M C Alvarado
- Division of Developmental and Cognitive Neuroscience, Yerkes National Primate Research Centre, Emory University, Atlanta, GA, USA
| | - K L Murphy
- Comparative Biology Centre, Newcastle University, Newcastle, UK
| | - M G Baxter
- Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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136
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Noguchi KK, Johnson SA, Dissen GA, Martin LD, Manzella FM, Schenning KJ, Olney JW, Brambrink AM. Isoflurane exposure for three hours triggers apoptotic cell death in neonatal macaque brain. Br J Anaesth 2019; 119:524-531. [PMID: 28969320 DOI: 10.1093/bja/aex123] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 01/21/2023] Open
Abstract
Background Retrospective clinical studies suggest there is a risk for neurodevelopmental impairment following early childhood exposure to anaesthesia. In the developing animal brain, including those of non-human primates (NHPs), anaesthetics induce apoptotic cell death. We previously reported that a 5 h isoflurane (ISO) exposure in infant NHPs increases apoptosis 13-fold compared with control animals. However, the majority of paediatric surgeries requiring anaesthesia are of shorter durations. We examined whether 3 h ISO exposure similarly increases neuroapoptosis in the NHP developing brain. Methods Six-day-old NHP infants ( Macaca mulatta ) were exposed to 3 h of a surgical plane of ISO ( n =6) or to room air ( n =5). Following exposure, NHP brains were screened for neuronal and oligodendrocyte apoptosis using activated caspase-3 immunolabelling and unbiased stereology. Results ISO treatment increased apoptosis (neurones + oligodendrocyte) to greater than four times that in the control group [mean density of apoptotic profiles: 57 (SD 22) mm -3 vs 14 (SD 5.2) mm -3 , respectively]. Oligodendrocyte apoptosis was evenly distributed throughout the white matter whereas neuroapoptosis occurred primarily in the cortex (all regions), caudate, putamen and thalamus. Conclusions A 3 h exposure to ISO is sufficient to induce widespread neurotoxicity in the developing primate brain. These results are relevant for clinical medicine, as many surgical and diagnostic procedures in children require anaesthesia durations similar to those modelled here. Further research is necessary to identify long-term neurobehavioural consequences of 3 h ISO exposure.
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Affiliation(s)
- K K Noguchi
- Department of Psychiatry, Washington University in St Louis, 660?S. Euclid Ave, St Louis, MO 63108, USA
| | - S A Johnson
- Department of Internal Medicine, University of Missouri, Columbia, Columbia, MO 65212, USA
| | - G A Dissen
- Division of Neuroscience, Oregon Health & Science University, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA
| | - L D Martin
- Division of Comparative Medicine, Oregon Health & Science University, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA
| | - F M Manzella
- Department of Psychiatry, Washington University in St Louis, 660?S. Euclid Ave, St Louis, MO 63108, USA
| | - K J Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239, USA
| | - J W Olney
- Department of Psychiatry, Washington University in St Louis, 660?S. Euclid Ave, St Louis, MO 63108, USA
| | - A M Brambrink
- Department of Anesthesia, Columbia University/NewYork-Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA
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137
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O’Leary JD, Janus M, Duku E, Wijeysundera DN, To T, Li P, Maynes JT, Faraoni D, Crawford MW. Influence of Surgical Procedures and General Anesthesia on Child Development Before Primary School Entry Among Matched Sibling Pairs. JAMA Pediatr 2019; 173:29-36. [PMID: 30398535 PMCID: PMC6583453 DOI: 10.1001/jamapediatrics.2018.3662] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Substantial preclinical evidence suggests that the developing brain is susceptible to injury from anesthetic drugs. Findings from clinical studies of the neurotoxic effects of anesthesia are mixed, but these effects can be influenced by unmeasured confounding from biological and environmental risk and protective factors on child development. OBJECTIVE To examine the association between surgical procedures that require general anesthesia before primary school entry and child development in biological siblings. DESIGN, SETTING, AND PARTICIPANTS This retrospective sibling-matched cohort study included sibling pairs aged 5 to 6 years with the same birth mother who had Early Development Instrument (EDI) data completed. The EDI is a population-based measure of child development that assesses children's readiness to learn in 5 major domains (physical health and well-being, social knowledge and competence, emotional health and maturity, language and cognitive development, and communication skills and general knowledge). All eligible children in public and Catholic schools in Ontario, Canada, from 2004 through 2012 were included. Data were analyzed from December 13, 2017, through July 27, 2018. EXPOSURES Surgical procedures that require general anesthesia from the date of birth to EDI completion. MAIN OUTCOMES AND MEASURES Early developmental vulnerability, defined as any major domain of the EDI in the lowest 10th percentile of the Ontario population. RESULTS Of the 187 226 eligible children for whom the EDI was completed, a total of 10 897 sibling pairs (21 794 children; 53.8% female; mean [SD] age, 5.7 [0.3] years) were subsequently identified, including 2346 with only 1 child exposed to surgery. No significant differences were found between exposed and unexposed children in early developmental vulnerability (697 of 3080 [22.6%] vs 3739 of 18 714 [20.0%]; adjusted odds ratio [aOR], 1.03; 95% CI, 0.98-1.14; P = .58) or for each of the 5 major EDI domains (aOR for language and cognitive development, 0.96 [95% CI, 0.80-1.14]; aOR for physical health and well-being, 1.09 [95% CI, 0.96-1.24]; aOR for social knowledge and competence, 0.98 [95% CI, 0.84-1.14]; aOR for emotional health and maturity, 0.98 [95% CI, 0.84-1.14]; and aOR for communication skills and general knowledge, 0.90 [95% CI, 0.77-1.05]), after adjusting for confounding factors (age at EDI completion, sex, mother's age at birth, and eldest sibling status). CONCLUSIONS AND RELEVANCE In this provincial cohort study, children who had surgical procedures that require general anesthesia before primary school entry were not found to be at increased risk of adverse child development outcomes compared with their biological siblings who did not have surgery. These findings further support that anesthesia exposure in early childhood is not associated with detectable adverse child development outcomes.
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Affiliation(s)
- James D. O’Leary
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duminda N. Wijeysundera
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada,Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ping Li
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Jason T. Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - David Faraoni
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Mark W. Crawford
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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138
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Talpos JC, Chelonis JJ, Li M, Hanig JP, Paule MG. Early life exposure to extended general anesthesia with isoflurane and nitrous oxide reduces responsivity on a cognitive test battery in the nonhuman primate. Neurotoxicology 2019; 70:80-90. [DOI: 10.1016/j.neuro.2018.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/24/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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139
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Xu L, Hu Y, Huang L, Liu Y, Wang B, Xie L, Hu Z. The association between attention deficit hyperactivity disorder and general anaesthesia - a narrative review. Anaesthesia 2018; 74:57-63. [PMID: 30511754 DOI: 10.1111/anae.14496] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- L. Xu
- Department of Anesthesiology; Women's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Y. Hu
- Department of Cell Biology; Yale University; New Haven CT USA
| | - L. Huang
- Department of Anesthesiology; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Y. Liu
- Department of Anesthesiology; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - B. Wang
- Department of Anesthesiology; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - L. Xie
- Department of Anesthesiology; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
| | - Z. Hu
- Department of Anesthesiology; The Children's Hospital; Zhejiang University School of Medicine; Hangzhou China
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140
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Vilanova-Sánchez A, Reck CA, Wood RJ, Garcia Mauriño C, Gasior AC, Dyckes RE, McCracken K, Weaver L, Halleran DR, Diefenbach K, Minzler D, Rentea RM, Ching CB, Jayanthi VR, Fuchs M, Dajusta D, Hewitt GD, Levitt MA. Impact on Patient Care of a Multidisciplinary Center Specializing in Colorectal and Pelvic Reconstruction. Front Surg 2018; 5:68. [PMID: 30510931 PMCID: PMC6254132 DOI: 10.3389/fsurg.2018.00068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/23/2018] [Indexed: 01/08/2023] Open
Abstract
Aim of the study: Many patients with an anorectal malformation (ARM) or pelvic anomaly have associated urologic or gynecologic problems. We hypothesized that our multidisciplinary center, which integrates pediatric colorectal, urologic, gynecologic and GI motility services, could impact a patient's anesthetic exposures and hospital visits. Methods: We tabulated during 2015 anesthetic/surgical events, endotracheal intubations, and clinic/hospital visits for all patients having a combined procedure. Main results: Eighty two patients underwent 132 combined procedures (Table 1). The median age at intervention was 3 years [0.2-17], and length of follow up was 25 months [7-31]. The number of procedures in patients who underwent combined surgery was lower as compared to if they had been done independently [1(1-5) vs. 3(2-7) (p < 0.001)]. Intubations were also lower [1[1-3] vs. 2[1-6]; p < 0.001]. Hospital length of stay was significantly lower for the combined procedures vs. the theoretical individual procedures [8 days [3-20] vs. 10 days [4-16]] p < 0.05. Post-operative clinic visits were fewer when combined visits were coordinated as compared to the theoretical individual clinic visits (urology, gynecology, and colorectal) [1[1-4] vs. 2[1-6]; p = < 0.001]. Conclusions: Patients with anorectal and pelvic malformations are likely to have many medical or surgical interventions during their lifetime. A multidisciplinary approach can reduce surgical interventions, anesthetic procedures, endotracheal intubations, and hospital/outpatient visits.
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Affiliation(s)
- Alejandra Vilanova-Sánchez
- Pediatric Surgery, Colorectal and Pelvic Surgery Division, Hospital Universitario La Paz, Madrid, Spain.,Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Robert E Dyckes
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Katherine McCracken
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Karen Diefenbach
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Dennis Minzler
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Rebecca M Rentea
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Christina B Ching
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Molly Fuchs
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Daniel Dajusta
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Geri D Hewitt
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, United States
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141
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Jin H, Komita M, Aoe T. Decreased Protein Quality Control Promotes the Cognitive Dysfunction Associated With Aging and Environmental Insults. Front Neurosci 2018; 12:753. [PMID: 30443201 PMCID: PMC6221900 DOI: 10.3389/fnins.2018.00753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Most neurodegenerative diseases are sporadic and develop with age. Degenerative neural tissues often contain intra- and extracellular protein aggregates, suggesting that the proteostasis network that combats protein misfolding could be dysfunctional in the setting of neurodegenerative disease. Binding immunoglobulin protein (BiP) is an endoplasmic reticulum (ER) chaperone that is crucial for protein folding and modulating the adaptive response in early secretory pathways. The interaction between BiP and unfolded proteins is mediated by the substrate-binding domain and nucleotide-binding domain with ATPase activity. The interaction facilitates protein folding and maturation. BiP has a recovery motif at the carboxyl terminus. The aim of this study is to examine cognitive function in model mice with an impaired proteostasis network by expressing a mutant form of BiP lacking the recovery motif. We also investigated if impairments of cognitive function were exacerbated by exposure to environmental insults, such as inhaled anesthetics. Methods: We examined cognitive function by performing radial maze testing with mutant BiP mice and assessed the additional impact of general anesthesia in the context of proteostasis dysfunction. Testing over 8 days was performed 10 weeks, 6 months, and 1 year after birth. Results: Age-related cognitive decline occurred in both forms of mice. The mutant BiP and anesthetic exposure promoted cognitive dysfunction prior to the senile period. After senescence, when mice were tested at 6 months of age and at 1 year old, there were no significant differences between the two genotypes in terms of the radial maze testing; furthermore, there was no significant difference when tested with and without anesthetic exposure. Conclusion: Our data suggest that aging was the predominant factor underlying the impairment of cognitive function in this study. Impairment of the proteostasis network may promote age-related neurodegeneration, and this is exacerbated by external insults.
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Affiliation(s)
- Hisayo Jin
- Department of Anesthesiology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mari Komita
- Department of Anesthesiology, Chiba Rosai Hospital, Ichihara, Japan
| | - Tomohiko Aoe
- Department of Medicine, Pain Center, Chiba Medical Center, Teikyo University, Ichihara, Japan
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142
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Affiliation(s)
- Susan Lei
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| | - Riva Ko
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| | - Lena S Sun
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA; Department of Pediatrics, Columbia University Medical Center, New York, NY 01132, USA.
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143
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Abstract
We provide a synopsis of innovative research, recurring themes, and novel experimental findings pertinent to the care of neurosurgical patients and critically ill patients with neurological diseases. We cover the following broad topics: general neurosurgery, spine surgery, stroke, traumatic brain injury, monitoring, and anesthetic neurotoxicity.
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144
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Yang J, Ju L, Yang C, Xue J, Setlow B, Morey TE, Gravenstein N, Seubert CN, Vasilopoulos T, Martynyuk AE. Effects of combined brief etomidate anesthesia and postnatal stress on amygdala expression of Cl - cotransporters and corticotropin-releasing hormone and alcohol intake in adult rats. Neurosci Lett 2018; 685:83-89. [PMID: 30125644 DOI: 10.1016/j.neulet.2018.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 01/18/2023]
Abstract
Early life stressors, including general anesthesia, can have adverse effects on adult neural and behavioral outcomes, such as disruptions in inhibitory signaling, stress responsivity and increased risk of psychiatric disorders. Here we used a rat model to determine the effects of combined exposure to etomidate (ET) neonatal anesthesia and maternal separation on adult amygdala expression of genes for corticotropin-releasing hormone (Crh) and the chloride co-transporters Nkcc1 and Kcc2, as well as ethanol intake. Male and female Sprague-Dawley rats were subjected to 2 h of ET anesthesia on postnatal days (P) 4, 5, or 6 followed by maternal separation for 3 h on P10 (ET + SEP). During the P91-P120 period rats had daily 2 h access to three 0.05% saccharin solutions containing 0%, 5%, or 10% ethanol, followed by gene expression analyses. The ET + SEP group had increased Crh mRNA levels and Nkcc1/Kcc2 mRNA ratios in the amygdala, with greater increases in Nkcc1/Kcc2 mRNA ratios in males. A moderate increase in 5% ethanol intake was evident in the ET + SEP males, but not females, after calculation of the ratio of alcohol intake between the last week and first week of exposure. In contrast, control males tended to decrease alcohol consumption during the same period. A brief exposure to ET combined with a subsequent episode of stress early in life induced significant alterations in expression of amygdala Crh, Nkcc1 and Kcc2 with greater changes in the Cl- transporter expression in males. The possibility of increased alcohol intake in the exposed males requires further confirmation using different alcohol intake paradigms.
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Affiliation(s)
- Jiaojiao Yang
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Lingsha Ju
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Chunyao Yang
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Jinhu Xue
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Barry Setlow
- The McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States; Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, United States
| | - Timothy E Morey
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Nikolaus Gravenstein
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States; The McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
| | - Christoph N Seubert
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Anatoly E Martynyuk
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States; The McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States.
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145
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Long-Term Neurobehavioral Consequences of a Single Ketamine Neonatal Exposure in Rats: Effects on Cellular Viability and Glutamate Transport in Frontal Cortex and Hippocampus. Neurotox Res 2018; 34:649-659. [PMID: 29968149 DOI: 10.1007/s12640-018-9927-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
The neonatal exposure to general anesthetics has been associated with neuronal apoptosis and dendritic spines morphologic changes in the developing brain. Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, is widely used in pediatric patients to induce general anesthesia, analgesia, and perioperative sedation. In the present study, we investigated short- and long-term effects of a single ketamine (20 mg/kg, s.c.) neonatal exposure at postnatal day 7 in rats on the hippocampal and frontal cortical cellular viability. Additionally, putative neurochemical alterations and neurobehavioral impairments were evaluated in the adulthood. Ketamine neonatal administration selectively decreased cellular viability in the hippocampus, but not in the frontal cortex, 24 h after the treatment. Interestingly, a single ketamine neonatal exposure prevented the vulnerability to glutamate-induced neurotoxicity in the frontal cortex of adult rats. No short- or long-term damage to cellular membranes, as an indicative of cell death, was observed in hippocampal or cortical slices. However, ketamine induced a long-term increase in hippocampal glutamate uptake. Regarding behavioral analysis, neonatal ketamine exposure did not alter locomotor activity and anxiety-related parameters evaluated in the open-field test. However, ketamine administration disrupted the hippocampal-dependent object recognition ability of adult rats, while improved the motor coordination addressed on the rotarod. These findings indicate that a single neonatal ketamine exposure induces a short-term reduction in the hippocampal, but not in cortical, cellular viability, and long-term alterations in hippocampal glutamate transport, improvement on motor performance, and short-term recognition memory impairment.
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146
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Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, Knoester H, Pollack MM, Rennick J, Curley MAQ. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr 2018; 198:16-24. [PMID: 29728304 DOI: 10.1016/j.jpeds.2017.12.084] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Scott Watson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
| | - Karen Choong
- Department of Pediatrics and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sheri Crow
- Department of Pediatrics and Health Services Research, Mayo Clinic, Rochester, MN
| | - Leslie A Dervan
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Ramona O Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT; Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT; Department of Medicine, Pulmonary & Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Hennie Knoester
- Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Murray M Pollack
- Children's National Health System, George Washington University, Washington, DC
| | - Janet Rennick
- Department of Nursing, Montreal Children's Hospital, Ingram School of Nursing and Department of Pediatrics (Division of Critical Care), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA
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147
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Zhong Y, Chen J, Li L, Qin Y, Wei Y, Pan S, Jiang Y, Chen J, Xie Y. PKA-CREB-BDNF signaling pathway mediates propofol-induced long-term learning and memory impairment in hippocampus of rats. Brain Res 2018; 1691:64-74. [DOI: 10.1016/j.brainres.2018.04.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 03/22/2018] [Accepted: 04/19/2018] [Indexed: 02/07/2023]
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148
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Abstract
Considering that growing population of very young children is exposed to general anesthesia every year, it is of utmost importance to understand how and whether such practice may affect the development and growth of their very immature and vulnerable brains. Compelling evidence from animal studies suggests that an early exposure to general anesthesia is detrimental to normal brain development leading to structural and functional impairments of neurons and glia, and long-lasting impairments in normal emotional and cognitive development. Although the evidence from animal studies is overwhelming and confirmed across species examined from rodents to non-human primates, the evidence from human studies is inconsistent and not conclusive at present. In this review we focus on new developments in animal studies of anesthesia-induced developmental neurotoxicity and summarize recent clinical studies while focusing on outcome measures and exposure variables in terms of their utility for assessing cognitive and behavioral development in children.
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Affiliation(s)
| | - Ansgar Brambrick
- Department of Anesthesiology, Columbia University Medical Center, New York, NY USA
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149
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Long-term neurocognitive outcomes following surgery and anaesthesia in early life. Curr Opin Anaesthesiol 2018; 31:297-301. [DOI: 10.1097/aco.0000000000000577] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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150
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Clausen N, Kähler S, Hansen T. Systematic review of the neurocognitive outcomes used in studies of paediatric anaesthesia neurotoxicity. Br J Anaesth 2018; 120:1255-1273. [DOI: 10.1016/j.bja.2017.11.107] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/22/2017] [Accepted: 11/21/2017] [Indexed: 01/08/2023] Open
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