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Khochfe AR, Rajab M, Ziade F, Naja ZZ, Naja AS, Naja ZM. The effect of regional anaesthesia versus general anaesthesia on behavioural functions in children. Anaesth Crit Care Pain Med 2018; 38:357-361. [PMID: 29684656 DOI: 10.1016/j.accpm.2018.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/15/2018] [Accepted: 03/31/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE The primary objective was to assess the effect of general anaesthesia versus regional anaesthesia in a single exposure before the age of 2 years on the development of long-term behavioural changes in children. METHODS The study was conducted between January 2014 and March 2015. Medical records of eligible children were reviewed. Then, parents of children who were included in the study were contacted and asked to visit the Outpatient Department to fill the Eyberg Child Behaviour Inventory questionnaire to measure behavioural changes in children. Children who were exposed to regional or general anaesthesia for surgery between January 2002 and December 2006 were included. Data collected were age and weight at the time of the first anaesthesia exposure and surgery duration. Chi-square test, t-test and multivariate analysis were used. RESULTS In total, 394 children were exposed to anaesthesia before the age of 2 years. Among the 168 patients who were exposed to general anaesthesia, 44 children (26.2%) developed behavioural abnormalities compared to 12 out of 226 patients (5.3%) who were exposed to regional anaesthesia (P-value<0.0001). Exposure to anaesthesia before age of 2 years increases the risk of developing behavioural disorder when surgery is accompanied by general anaesthesia, younger age at time of exposure, and longer surgery duration (P-value<0.0001, 0.001, 0.038 respectively). CONCLUSION Regional anaesthesia showed much lesser effect on children's behaviour compared to general anaesthesia. The incidence of behavioural disorder is increased with the use of general anaesthesia, younger age of the patient at time of exposure, and longer surgery duration.
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Affiliation(s)
| | - Mariam Rajab
- Paediatrics Department, Makassed General Hospital, Beirut, Lebanon
| | - Fouad Ziade
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Zeina Z Naja
- Paediatrics Department, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Zoher M Naja
- Anaesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon.
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152
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Abstract
Abstract
A recent U.S. Food and Drug Administration warning advised that prolonged or repeated exposure to general anesthetics may affect neurodevelopment in children. This warning is based on a wealth of preclinical animal studies and relatively few human studies. The human studies include a variety of different populations with several different outcome measures. Interpreting the results requires consideration of the outcome used, the power of the study, the length of exposure and the efforts to reduce the confounding effects of comorbidity and surgery. Most, but not all, of the large population-based studies find evidence for associations between surgery in early childhood and slightly worse subsequent academic achievement or increased risk for later diagnosis of a behavioral disability. In several studies, the amount of added risk is very small; however, there is some evidence for a greater association with multiple exposures. These results may be consistent with the preclinical data, but the possibility of confounding means the positive associations can only be regarded as weak evidence for causation. Finally, there is strong evidence that brief exposure is not associated with any long term risk in humans.
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153
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Raper J, De Biasio JC, Murphy KL, Alvarado MC, Baxter MG. Persistent alteration in behavioural reactivity to a mild social stressor in rhesus monkeys repeatedly exposed to sevoflurane in infancy. Br J Anaesth 2018; 120:761-767. [PMID: 29576116 PMCID: PMC6200105 DOI: 10.1016/j.bja.2018.01.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/11/2017] [Accepted: 01/02/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Socio-emotional development is the expression and management of emotions, which in non-human primates can be examined using responses toward increasing levels of threat. Damage to the limbic system alters socio-emotional development in primates. Thus, neuronal and glial cell loss caused by exposure to general anaesthesia early in infancy might also impact socio-emotional development. We recently reported that repeated sevoflurane exposure in the first month of life alters emotional behaviours at 6 months of age and impairs visual recognition memory after the first year of life in rhesus monkeys. The present study evaluated socio-emotional behaviour at 1 and 2 yr of age in those same monkeys to determine the persistence of altered emotional behaviour. METHODS Rhesus monkeys of both sexes were exposed to sevoflurane anaesthesia three times for 4 h each time in the first 6 weeks of life. At 1 and 2 yr of age, they were tested on the human intruder task, a well-established mild acute social stressor. RESULTS Monkeys exposed to sevoflurane as infants exhibited normal fear and hostile responses, but exaggerated self-directed (displacement) behaviours, a general indicator of stress and anxiety in non-human primates. CONCLUSIONS Early repeated sevoflurane exposure in infant non-human primates results in an anxious phenotype that was first detected at 6 months, and persists for at least 2 yr of age. This is the first demonstration of such a prolonged impact of early anaesthesia exposure on emotional reactivity.
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Affiliation(s)
- J Raper
- Division of Developmental and Cognitive Neuroscience, Yerkes National Primate Research Center, Atlanta, GA, USA.
| | - J C De Biasio
- Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K L Murphy
- Comparative Biology Centre, Newcastle University, Newcastle, UK
| | - M C Alvarado
- Division of Developmental and Cognitive Neuroscience, Yerkes National Primate Research Center, Atlanta, GA, USA
| | - M G Baxter
- Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Noguchi KK, Johnson SA, Manzella FM, Masuoka KL, Williams SL, Martin LD, Dissen GA, Ikonomidou C, Schenning KJ, Olney JW, Brambrink AM. Caffeine Augments Anesthesia Neurotoxicity in the Fetal Macaque Brain. Sci Rep 2018; 8:5302. [PMID: 29593226 PMCID: PMC5871879 DOI: 10.1038/s41598-018-23560-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/14/2018] [Indexed: 01/18/2023] Open
Abstract
Caffeine is the most frequently used medication in premature infants. It is the respiratory stimulant of choice for apnea associated with prematurity and has been called the silver bullet in neonatology because of many proven benefits and few known risks. Research has revealed that sedative/anesthetic drugs trigger apoptotic death of neurons and oligodendrocytes in developing mammalian brains. Here we evaluated the influence of caffeine on the neurotoxicity of anesthesia in developing nonhuman primate brains. Fetal macaques (n = 7–8/group), at a neurodevelopmental age comparable to premature human infants, were exposed in utero for 5 hours to no drug (control), isoflurane, or isoflurane + caffeine and examined for evidence of apoptosis. Isoflurane exposure increased apoptosis 3.3 fold for neurons and 3.4 fold for oligodendrocytes compared to control brains. Isoflurane + caffeine caused neuronal apoptosis to increase 8.0 fold compared to control levels but did not augment oligoapoptosis. Neuronal death was particularly pronounced in the basal ganglia and cerebellum. Higher blood levels of caffeine within the range considered therapeutic and safe for human infants correlated with increased neuroapoptosis. Caffeine markedly augments neurotoxicity of isoflurane in the fetal macaque brain and challenges the assumption that caffeine is safe for premature infants.
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Affiliation(s)
- Kevin K Noguchi
- Department of Psychiatry, Washington University in St Louis, St. Louis, MO, 63130, USA.
| | - Stephen A Johnson
- Mayo Clinic, Department of Neurology, Rochester, Minnesota, United States
| | - Francesca M Manzella
- Department of Anesthesiology, Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kobe L Masuoka
- Department of Psychology, University of Missouri, St Louis, USA
| | - Sasha L Williams
- Department of Psychiatry, Washington University in St Louis, St. Louis, MO, 63130, USA
| | - Lauren D Martin
- Division of Comparative Medicine, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Gregory A Dissen
- Division of Neuroscience, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | | | - Katie J Schenning
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - John W Olney
- Department of Psychiatry, Washington University in St Louis, St. Louis, MO, 63130, USA
| | - Ansgar M Brambrink
- Department of Anesthesiology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, 10032, USA.
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155
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Maloney SE, Creeley CE, Hartman RE, Yuede CM, Zorumski CF, Jevtovic-Todorovic V, Dikranian K, Noguchi KK, Farber NB, Wozniak DF. Using animal models to evaluate the functional consequences of anesthesia during early neurodevelopment. Neurobiol Learn Mem 2018; 165:106834. [PMID: 29550366 DOI: 10.1016/j.nlm.2018.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/16/2018] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
Fifteen years ago Olney and colleagues began using animal models to evaluate the effects of anesthetic and sedative agents (ASAs) on neurodevelopment. The results from ongoing studies indicate that, under certain conditions, exposure to these drugs during development induces an acute elevated apoptotic neurodegenerative response in the brain and long-term functional impairments. These animal models have played a significant role in bringing attention to the possible adverse effects of exposing the developing brain to ASAs when few concerns had been raised previously in the medical community. The apoptotic degenerative response resulting from neonatal exposure to ASAs has been replicated in many studies in both rodents and non-human primates, suggesting that a similar effect may occur in humans. In both rodents and non-human primates, significantly increased levels of apoptotic degeneration are often associated with functional impairments later in life. However, behavioral deficits following developmental ASA exposure have not been consistently reported even when significantly elevated levels of apoptotic degeneration have been documented in animal models. In the present work, we review this literature and propose a rodent model for assessing potential functional deficits following neonatal ASA exposure with special reference to experimental design and procedural issues. Our intent is to improve test sensitivity and replicability for detecting subtle behavioral effects, and thus enhance the translational significance of ASA models.
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Affiliation(s)
- Susan E Maloney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA
| | - Catherine E Creeley
- Department of Psychology, The State University of New York at Fredonia, Fredonia, NY 14063, USA
| | - Richard E Hartman
- Department of Psychology, Loma Linda University, 11130 Anderson St., Loma Linda, CA 92354, USA
| | - Carla M Yuede
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles F Zorumski
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Krikor Dikranian
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin K Noguchi
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA
| | - Nuri B Farber
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, 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, 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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157
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A neurosteroid analogue with T-type calcium channel blocking properties is an effective hypnotic, but is not harmful to neonatal rat brain. Br J Anaesth 2018; 120:768-778. [PMID: 29576117 DOI: 10.1016/j.bja.2017.12.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND More than 4 million children are exposed annually to sedatives and general anaesthetics (GAs) in the USA alone. Recent data suggest that common GAs can be detrimental to brain development causing neurodegeneration and long-term cognitive impairments. Challenged by a recent US Food and Drug Administration (FDA) warning about potentially neurotoxic effects of GAs in children, there is an urgent need to develop safer GAs. METHODS Postnatal Day 7 (P7) rat pups of both sexes were exposed to six (repeated every 2 h) injections of equipotent hypnotic doses of ketamine or the neuroactive steroid (3β,5β,17β)-3-hydroxyandrostane-17-carbonitrile (3β-OH) for 12 h. Loss of righting reflex was used to assess hypnotic properties and therapeutic index; quantitative caspase-3 immunohistochemistry was used to assess developmental neuroapoptosis; patch-clamp recordings in acute brain slices were used to assess the effects of 3β-OH on neuronal excitability and synaptic transmission. Cognitive abilities of rats exposed to ketamine, 3β-OH, or vehicle at P7 were assessed in young adulthood using the radial arm maze. RESULTS The neuroactive steroid 3β-OH has a therapeutic index similar to ketamine, a commonly used clinical GA. We report that 3β-OH is safe and, unlike ketamine, does not cause neuroapoptosis or impair cognitive development when administered to P7 rat pups. Interestingly, 3β-OH blocks T-type calcium channels and presynaptically dampens synaptic transmission at hypnotically-relevant brain concentrations, but it lacks a direct effect on γ-aminobutyric acid A or glutamate-gated ion channels. CONCLUSIONS The neurosteroid 3β-OH is a relatively safe hypnotic that warrants further consideration for paediatric anaesthesia.
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158
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Tsai CJ, Lee CTC, Liang SHY, Tsai PJ, Chen VCH, Gossop M. Risk of ADHD After Multiple Exposures to General Anesthesia: A Nationwide Retrospective Cohort Study. J Atten Disord 2018; 22:229-239. [PMID: 26023173 DOI: 10.1177/1087054715587094] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To study the association between general anesthesia exposure before age 3 years and having a later ADHD diagnosis. METHOD In a birth cohort, data were collected from a nationwide population database for children born between 1997 and 1999 who were exposed to general anesthesia before their third birthday. Age- and gender-matched enrollees without general anesthesia exposure were taken as the comparison. Groups were compared to identify the incidence of ADHD after age 4 and anesthesia-related predictive factors. RESULTS Among the 1,146 exposed children, 74 ADHD cases were identified, and 158 ADHD cases were identified in 3,438 matched controls. After adjusting for comorbid conditions and possible confounding factors, if exposure on more than one occasion or ≥3 hr, an increased likelihood of having a later ADHD diagnosis was found (HR, 1.71 and 2.43, respectively). CONCLUSION Children with multiple or ≥3 hr general anesthesia exposures before age 3 years have an increased likelihood of a later ADHD diagnosis.
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Affiliation(s)
| | - Charles Tzu-Chi Lee
- 2 Kaohsiung Medical University, Taiwan.,3 National Taiwan Normal University, Taipei, Taiwan
| | - Sophie Hsin-Yi Liang
- 4 Chang Gung Memorial Hospital, Taoyuan, Taiwan.,5 Chang Gung University, Taoyuan, Taiwan
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159
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Effects on adult cognitive function after neonatal exposure to clinically relevant doses of ionising radiation and ketamine in mice. Br J Anaesth 2018; 120:546-554. [PMID: 29452811 DOI: 10.1016/j.bja.2017.11.099] [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: 02/18/2017] [Revised: 10/31/2017] [Accepted: 11/10/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Radiological methods for screening, diagnostics and therapy are frequently used in healthcare. In infants and children, anaesthesia/sedation is often used in these situations to relieve the patients' perception of stress or pain. Both ionising radiation (IR) and ketamine have been shown to induce developmental neurotoxic effects and this study aimed to identify the combined effects of these in a murine model. METHODS Male mice were exposed to a single dose of ketamine (7.5 mg kg-1 body weight) s.c. on postnatal day 10. One hour after ketamine exposure, mice were whole body irradiated with 50-200 mGy gamma radiation (137Cs). Behavioural observations were performed at 2, 4 and 5 months of age. At 6 months of age, cerebral cortex and hippocampus tissue were analysed for neuroprotein levels. RESULTS Animals co-exposed to IR and ketamine displayed significant (P≤0.01) lack of habituation in the spontaneous behaviour test, when compared with controls and single agent exposed mice. In the Morris Water Maze test, co-exposed animals showed significant (P≤0.05) impaired learning and memory capacity in both the spatial acquisition task and the relearning test compared with controls and single agent exposed mice. Furthermore, in co-exposed mice a significantly (P≤0.05) elevated level of tau protein in cerebral cortex was observed. Single agent exposure did not cause any significant effects on the investigated endpoints. CONCLUSION Co-exposure to IR and ketamine can aggravate developmental neurotoxic effects at doses where the single agent exposure does not impact on the measured variables. These findings show that estimation of risk after paediatric low-dose IR exposure, based upon radiation dose alone, may underestimate the consequences for this vulnerable population.
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160
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Dobberpuhl MR, Timoney PJ, Comer BT. Endoscopically Assisted Crawford Tube Placement Results in Shorter General Anesthesia Times in Pediatric Patients. Am J Rhinol Allergy 2018; 32:31-33. [DOI: 10.2500/ajra.2018.32.4500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Crawford tube placement is commonly used to achieve patency of nasolacrimal ducts for epiphora secondary to nasolacrimal duct obstruction. The nasal passages of pediatric patients are narrower than adults, and the result is a relatively higher risk of intranasal complications (e.g., synechiae, bleeding) with Crawford tube placement. There is evidence that general anesthesia may negatively affect the neurocognitive function and behavioral development of children, which prompts efforts to decrease operation times for potential health benefits and also potentially to reduce health care costs. Analysis ofresearch reports supports the use of nasal endoscopy to reduce intranasal complications with Crawford tube placement; however, no publications currently address the effect of nasal endoscopy concurrent with Crawford tube placement on operative times on pediatric patients or the resulting effects on health care costs. Objective To determine the difference in procedure time and cost between Crawford tubes placed traditionally and those placed with endoscopic assistance in pediatric patients. Methods A chart review was performed from January 1, 2011 to December 31, 2016 for cases using CPT codes 68815 or 31231. Within this group of patients, the patient in whom nasal endoscopy was performed were placed in the “endoscopic” group and the patients without endoscopy were placed in the “traditional” group. Procedure times were noted, and the t-test was performed to examine for any statistically significant difference in operative times. Estimates of anesthesia cost savings were made. We identified 24 patients in the traditional group and 7 patients in the endoscopic group. Results The average operative time for the traditional group was 27.3 minutes compared with 14.0 minutes for the endoscopic group (p = 0.02). The cost comparison data revealed no significant difference with the traditional group averaging $9369 per procedure and the endoscopic group averaging $8891 (p = 0.51). Conclusion An endoscopically assisted Crawford tube placement resulted in patients who had less time under general anesthesia compared with the traditional technique at no difference in cost.
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Affiliation(s)
| | - Peter J. Timoney
- Department of Ophthalmology, University of Kentucky, Lexington, Kentucky
| | - Brett T. Comer
- Department of Otolaryngology, University of Kentucky, Lexington, Kentucky
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161
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Ketamine induces neuronal apoptosis and cognitive disorder via miR-199a-5p/HIF-1α in neonatal rats. Mol Cell Toxicol 2017. [DOI: 10.1007/s13273-017-0044-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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163
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朱 晓, 林 春, 郭 培, 李 平, 刘 川. [Effects of propofol on myelin basic protein expression in oligodendrocytes of SD rats at different developmental stages]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1615-1619. [PMID: 29292254 PMCID: PMC6744017 DOI: 10.3969/j.issn.1673-4254.2017.12.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the effect of propofol on myelin basic protein (MBP) expression in oligodendrocytes of SD rats at different developmental stages. METHODS This study was conducted in 3?, 7?, 14? and 21?day?old SD rats (40 in each age group). In each group, the rats were randomized equally into control group and experimental group, and in the control group, the rats received an intraperitoneal injection of 25 mg/kg medium?long?chain fat emulsion followed by injections at a half dose every 20 min for 8 h; the rats in the experimental group were given injections of propofolmedium (at the initial dose of 25 mg/kg) in the same manner. The transcriptional levels of MBP and caspase?3 in the brain tissues were detected by qRT?PCR, and the protein expression of MBP was with Western blotting and immunehistochemistry. RESULTS Compared with those in the control groups, the expression of MBP mRNA was significantly down?regulated while caspase?3 mRNA was up?regulated in 3?, 7? and 14?day?old rats in the experimental groups (P<0.05). The protein expression of MBP in 7? and 14?day?old rats was significantly decreased in the experimental groups compared with the control groups (P<0.05). The expression of caspase?3 mRNA or MBP protein in 21?day?old rats showed no significant difference between the two groups (P>0.05). CONCLUSION Propofol can down?regulate the expression of MBP at both the mRNA and protein levels in SD rats, especially in those at 7 and 14 days of age.
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Affiliation(s)
- 晓勤 朱
- />南方医科大学南方医院麻醉科,广东 广州 510515Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 春水 林
- />南方医科大学南方医院麻醉科,广东 广州 510515Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 培培 郭
- />南方医科大学南方医院麻醉科,广东 广州 510515Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 平 李
- />南方医科大学南方医院麻醉科,广东 广州 510515Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 川 刘
- />南方医科大学南方医院麻醉科,广东 广州 510515Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Huang L, Cichon J, Ninan I, Yang G. Post-anesthesia AMPA receptor potentiation prevents anesthesia-induced learning and synaptic deficits. Sci Transl Med 2017; 8:344ra85. [PMID: 27334260 DOI: 10.1126/scitranslmed.aaf7151] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/23/2016] [Indexed: 11/02/2022]
Abstract
Accumulating evidence has shown that repeated exposure to general anesthesia during critical stages of brain development results in long-lasting behavioral deficits later in life. To date, there has been no effective treatment to mitigate the neurotoxic effects of anesthesia on brain development. By performing calcium imaging in the mouse motor cortex, we show that ketamine anesthesia causes a marked and prolonged reduction in neuronal activity during the period of post-anesthesia recovery. Administration of the AMPAkine drug CX546 [1-(1,4-benzodioxan-6-ylcarbonyl)piperidine] to potentiate AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor activity during emergence from anesthesia in mice enhances neuronal activity and prevents long-term motor learning deficits induced by repeated neonatal anesthesia. In addition, we show that CX546 administration also ameliorates various synaptic deficits induced by anesthesia, including reductions in synaptic expression of NMDA (N-methyl-d-aspartate) and AMPA receptor subunits, motor training-evoked neuronal activity, and dendritic spine remodeling associated with motor learning. Together, our results indicate that pharmacologically enhancing neuronal activity during the post-anesthesia recovery period could effectively reduce the adverse effects of early-life anesthesia.
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Affiliation(s)
- Lianyan Huang
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Joseph Cichon
- Medical Scientist Training Program at New York University School of Medicine, New York, NY 10016, USA
| | - Ipe Ninan
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA
| | - Guang Yang
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University School of Medicine, New York, NY 10016, USA.
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165
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Nafiu OO, Davis PJ. Association of Surgery and Anesthesia With Mental Disorder Diagnoses: What Would Sir Austin Bradford Hill Say? Anesth Analg 2017; 125:1845-1848. [PMID: 29189364 DOI: 10.1213/ane.0000000000002567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Olubukola O Nafiu
- From the Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Peter J Davis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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Abstract
BACKGROUND Growing rod (GR) treatment for early-onset scoliosis requires repeated anesthesia exposure (AE). At a minimum, GR treatment requires AE for diagnostic imaging, index GR surgery, periodic lengthenings, and final fusion. Adjunct procedures and complication-related procedures also increase AE. To our knowledge, this is the first study to quantify AE in GR treatment and to establish preoperative expectations. METHODS A single-center retrospective review of 16 patients who completed GR treatment and underwent final fusion. Duration of all AE related to GR treatment for "standard" care procedures (ie, advanced imaging, index surgery, lengthenings, final fusion) and "associated" care procedures (ie, revisions, adjunctive surgical procedures, wound-related complications) were reviewed. Etiologies were classified per the classification of early-onset scoliosis. Mean total anesthesia time (TAT) was tallied and analyzed for standard care and associated care procedures. RESULTS There were 5 syndromic, 8 neuromuscular, and 3 idiopathic patients. The mean age at the first AE event related to GR treatment was 7.4 years (range, 3.8 to 11 y). Mean age at the index GR surgery and final fusion was 8.1 years (range, 3.9 to 14.4 y) and 12.8 years (range, 9.7 to 19 y), respectively. The percentage of TAT for each procedural category was 7% for advanced imaging, 14% for index GR, 14% for lengthenings, 21% for final fusion, 27% for revisions, 9% for adjunct surgery, and 9% for wound complications. Standard care procedures accounted for 55% of TAT, whereas associated care procedures accounted for 45%. CONCLUSIONS This study quantified expected duration of AE in GR treatment. Revisions and final fusion contributed most to TAT. Given the recent controversy of repeated AE in young children, efficiency measures should be implemented to reduce AE and avoid duplication without compromising the goals of surgical treatment. Associated care procedures accounted for 45% of the total AE. LEVEL OF EVIDENCE Level IV.
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167
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Ing C, Sun M, Olfson M, DiMaggio CJ, Sun LS, Wall MM, Li G. Age at Exposure to Surgery and Anesthesia in Children and Association With Mental Disorder Diagnosis. Anesth Analg 2017; 125:1988-1998. [PMID: 28857799 PMCID: PMC5856466 DOI: 10.1213/ane.0000000000002423] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Animals exposed to anesthetics during specific age periods of brain development experience neurotoxicity, with neurodevelopmental changes subsequently observed during adulthood. The corresponding vulnerable age in children, however, is unknown. METHODS An observational cohort study was performed using a longitudinal dataset constructed by linking individual-level Medicaid claims from Texas and New York from 1999 to 2010. This dataset was evaluated to determine whether the timing of exposure to anesthesia ≤5 years of age for a single common procedure (pyloromyotomy, inguinal hernia, circumcision outside the perinatal period, or tonsillectomy and/or adenoidectomy) is associated with increased subsequent risk of diagnoses for any mental disorder, or specifically developmental delay (DD) such as reading and language disorders, and attention deficit hyperactivity disorder (ADHD). Exposure to anesthesia and surgery was evaluated in 11 separate age at exposure categories: ≤28 days old, >28 days and ≤6 months, >6 months and ≤1 year, and 6-month age intervals between >1 year old and ≤5 years old. For each exposed child, 5 children matched on propensity score calculated using sociodemographic and clinical covariates were selected for comparison. Cox proportional hazards models were used to measure the hazard ratio of a mental disorder diagnosis associated with exposure to surgery and anesthesia. RESULTS A total of 38,493 children with a single exposure and 192,465 propensity score-matched children unexposed before 5 years of age were included in the analysis. Increased risk of mental disorder diagnosis was observed at all ages at exposure with an overall hazard ratio of 1.26 (95% confidence interval [CI], 1.22-1.30), which did not vary significantly with the timing of exposure. Analysis of DD and ADHD showed similar results, with elevated hazard ratios distributed evenly across all ages, and overall hazard ratios of 1.26 (95% CI, 1.20-1.32) for DD and 1.31 (95% CI, 1.25-1.37) for ADHD. CONCLUSIONS Children who undergo minor surgery requiring anesthesia under age 5 have a small but statistically significant increased risk of mental disorder diagnoses and DD and ADHD diagnoses, but the timing of the surgical procedure does not alter the elevated risks. Based on these findings, there is little support for the concept of delaying a minor procedure to reduce long-term neurodevelopmental risks of anesthesia in children. In evaluating the influence of age at exposure, the types of procedures included may need to be considered, as some procedures are associated with specific comorbid conditions and are only performed at certain ages.
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Affiliation(s)
- Caleb Ing
- From the Departments of Anesthesiology
- Epidemiology
| | - Ming Sun
- From the Departments of Anesthesiology
- Biostatistics, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, New York
| | - Mark Olfson
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Charles J DiMaggio
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Lena S Sun
- From the Departments of Anesthesiology
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Melanie M Wall
- Biostatistics, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, New York
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Guohua Li
- From the Departments of Anesthesiology
- Epidemiology
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168
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Chang HC, Liao CC, Chang CC, Huang SY, Yeh CC, Hu CJ, Cherng YG, Chen TL. Risk of epilepsy in surgical patients undergoing general or neuraxial anaesthesia. Anaesthesia 2017; 73:323-331. [DOI: 10.1111/anae.14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 12/23/2022]
Affiliation(s)
- H. C. Chang
- Department of Anaesthesiology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Anaesthesiology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
| | - C. C. Liao
- Department of Anaesthesiology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- School of Chinese Medicine; College of Chinese Medicine; China Medical University; Taichung Taiwan
| | - C. C. Chang
- Department of Anaesthesiology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Anaesthesiology; Taipei Medical University Hospital; Taipei Taiwan
| | - S. Y. Huang
- Department of Anaesthesiology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Anaesthesiology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
| | - C. C. Yeh
- Department of Surgery; China Medical University Hospital; Taichung Taiwan
- Department of Surgery; University of Illinois; Chicago United States of America
| | - C. J. Hu
- Department of Neurology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
| | - Y. G. Cherng
- Department of Anaesthesiology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Anaesthesiology; Shuang Ho Hospital; Taipei Medical University; New Taipei City Taiwan
| | - T. L. Chen
- Department of Anaesthesiology; Taipei Medical University Hospital; Taipei Taiwan
- Department of Anaesthesiology; School of Medicine; College of Medicine; Taipei Medical University; Taipei Taiwan
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169
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Li X, Wei K, Hu R, Zhang B, Li L, Wan L, Zhang C, Yao W. Upregulation of Cdh1 Attenuates Isoflurane-Induced Neuronal Apoptosis and Long-Term Cognitive Impairments in Developing Rats. Front Cell Neurosci 2017; 11:368. [PMID: 29218001 PMCID: PMC5703863 DOI: 10.3389/fncel.2017.00368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/07/2017] [Indexed: 11/13/2022] Open
Abstract
Neonatal exposure to isoflurane can result in neuroapoptosis and persistent cognitive impairments. However, the underlying mechanisms remain elusive. Anaphase-promoting complex/cyclosome (APC/C) and its co-activator Cdh1 are E3 ubiquitin ligases that play important roles in the central nervous system, including in the regulation of neuronal survival, synaptic development, and mammalian learning and memory. However, whether APC/C-Cdh1 is involved in isoflurane-induced neurotoxicity in developing rats remains unclear. In this study, postnatal day-7 (P7) rat pups and primary hippocampal neurons were exposed to 2% isoflurane for 6 h. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was used to detect neuronal apoptosis, and the expression of proteins involved in apoptosis (cleaved caspase-3, Bax and Bcl-2) was assessed by western blot. The level of Cdh1 in the hippocampus was downregulated during isoflurane-induced neuroapoptosis. Cdh1-encoding lentivirus was transfected before isoflurane-treatment to increase the level of Cdh1. Our results showed that Cdh1 overexpression by a recombinant Cdh1-encoding lentivirus reduced isoflurane-induced neuronal apoptosis. Moreover, bilateral intra-hippocampal injection with Cdh1-encoding lentivirus attenuated long-term cognitive deficits after exposure to isoflurane in developing rats. Our study indicates that Cdh1 is an important target to prevent isoflurane-induced developmental neurotoxicity.
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Affiliation(s)
- Xuan Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Wei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Hu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Li
- Department of Physiology, Hubei University of Chinese Medicine, Wuhan, China
| | - Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanhan Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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170
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Ho AMH, Fleming ML, Mizubuti GB. Anesthetic neurotoxicity and the developing brain. CMAJ 2017; 189:E1028-E1029. [PMID: 28808114 DOI: 10.1503/cmaj.170313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont
| | - Melinda L Fleming
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont.
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171
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Resheidat A, Quinonez ZA, Mossad EB, Wise-Faberowski L, Mittnacht AJC. Selected 2016 Highlights in Congenital Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2017; 31:1927-1933. [PMID: 29074129 DOI: 10.1053/j.jvca.2017.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ashraf Resheidat
- Division of Cardiovascular Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Zoel A Quinonez
- Division of Cardiovascular Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Emad B Mossad
- Division of Cardiovascular Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Lisa Wise-Faberowski
- Division of Pediatric Cardiac Anesthesia, Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Alexander J C Mittnacht
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
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172
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Yang J, Ju L, Jia M, Zhang H, Sun X, Ji M, Yang J, Martynyuk AE. Subsequent maternal separation exacerbates neurobehavioral abnormalities in rats neonatally exposed to sevoflurane anesthesia. Neurosci Lett 2017; 661:137-142. [PMID: 28982596 DOI: 10.1016/j.neulet.2017.09.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 12/16/2022]
Abstract
Several recent studies suggest that in the human population, a routine, short anesthetic in otherwise healthy infants is void of neurodevelopmental insult. On the other hand, many human retrospective epidemiological studies report evidence of cognitive abnormalities in children after testing those who had different anesthesia-requiring procedures in early childhood. We tested in a rat model whether post-anesthesia stressful environmental factors can contribute to developmental abnormalities that were initiated by a relatively short exposure to sevoflurane, the most widely used anesthetic in pediatric anesthesia, whose polyvalent actions include enhancement of gamma-aminobutyric acid type A receptor (GABAAR) activity. Postnatal day 6 (P6) male Sprague-Dawley rats were anesthetized with sevoflurane for 60min. To simulate subsequent stress, the animals were subjected to a single maternal separation for 180min at P10. To study the role of GABAAR-mediated depolarization, subgroups of P6 rats received a single injection of the Na+-K+-2Cl- (NKCC1) inhibitor, bumetanide, prior to initiation of anesthesia with sevoflurane. Rats that were exposed to sevoflurane had decreased hypothalamic K+-2Cl- (KCC2) mRNA level (F(2,13)=3.839, P=0.049), increased NKCC1/KCC2 mRNA ratio (F(2,13)=5.043, P=0.024) and increased corticotropin-releasing hormone (CRH) mRNA level (F(2,12)=9.450, P=0.003) at P10, the age at which maternal separation was imposed. Adult rats, neonatally exposed to a combination of sevoflurane and maternal separation, exhibited increases in the escape latencies greater than animals exposed to sevoflurane only (P=0.012), and only rats in the sevoflurane plus maternal separation group spent significantly less time in the target quadrant during the Morris water maze test (F(4,55)=4.856, P=0.002). Bumetanide ameliorated abnormalities induced by sevoflurane and a combination of sevoflurane plus maternal separation. Neonatal exposure to sevoflurane may sensitize to stressors later in life, and post-exposure stress may exacerbate neurodevelopmental abnormalities even after a relatively short exposure to sevoflurane in rodents. The NKCC1 downregulation prior to exposure to the anesthetic may be therapeutic.
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Affiliation(s)
- Jiaojiao Yang
- Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States; Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Lingsha Ju
- Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States; Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Min Jia
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Hui Zhang
- Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiaoru Sun
- Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Muhuo Ji
- Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jianjun Yang
- Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - Anatoly E Martynyuk
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States; McKnight Brain Institute, University of FL College of Medicine, Gainesville, FL, United States.
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173
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Álvarez Escudero J, Paredes Esteban RM, Cambra Lasaosa FJ, Vento M, López Gil M, de Agustín Asencio JC, Moral Pumarega MT. More than 3 hours and less than 3 years: Safety of anaesthetic procedures in infants less than 3 years old subected to surgery for more the 3 hours. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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174
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Álvarez Escudero J, Paredes Esteban RM, Cambra Lasaosa FJ, Vento M, López Gil M, de Agustín Asencio JC, Moral Pumarega MT. Más de 3 horas y menos de 3 años: Seguridad de procedimientos anestésicos en menores de 3 años sometidos a cirugía de más de 3 horas. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpedi.2017.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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175
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Antonov NK, Ruzal-Shapiro CB, Morel KD, Millar WS, Kashyap S, Lauren CT, Garzon MC. Feed and Wrap MRI Technique in Infants. Clin Pediatr (Phila) 2017; 56:1095-1103. [PMID: 27872353 DOI: 10.1177/0009922816677806] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The feed and wrap technique refers to the use of feeding and swaddling to induce natural sleep in infants. It can be used prior to an magnetic resonance imaging (MRI) scan, avoiding sedation or anesthesia. We performed a retrospective review of feed and wrap MRI scans in infants 3 months or younger over a 2-year period at our center (279 scans) to evaluate the efficacy of this technique. Of scan results reviewed, 79% addressed the clinical question, 20% partially addressed the clinical question, and 1% were technically inadequate. History of preterm birth (odds ratio [OR] = 2.368; P = .032) and spine MRI (OR = 2.821; P = .001) were associated with a less-successful scan outcome. The feed and wrap technique can be used successfully in infants undergoing MRI; however, it may be less successful in preterm infants and those requiring spinal MRI. A standardized technique performed by experienced personnel may avoid anesthesia and sedation in infants who require MRI.
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176
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Chari DA, Chan DK. Diagnosis and Treatment of Congenital Sensorineural Hearing Loss. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:251-258. [PMID: 29761033 DOI: 10.1007/s40136-017-0163-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose of Review The aim of this report is to review current literature regarding the work-up and management of congenital sensorineural hearing loss. Recent Findings Diagnostic evaluation of a newborn with sensorineural hearing loss begins with a complete audiologic evaluation and comprehensive history and physical exam. This review presents a diagnostic algorithm for the work-up of congenital hearing loss, focusing on the three following modalities: cytomegalovirus testing, genetic evaluation, and imaging. Summary Newborn hearing loss is a common problem and may be attributed to genetic and non-genetic factors. Complete diagnostic evaluation and treatment are essential for preventing delays in language development. Treatment consists of early intervention services and consideration of hearing aid amplification and cochlear implantation.
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Affiliation(s)
- Divya A Chari
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Dylan K Chan
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
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177
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Abstract
RESEARCH QUESTION Is there an association between regular exercise, defined as a structured program of increased physical activity at least 1 month in duration, and improvements in measures of executive functions compared with children who engage in their normal daily activities? CONTEXT The association between increased physical activity and changes in performance on tasks of executive functions have not been well elucidated in children. Executive functioning is important to intellectual development and academic success in children, and inexpensive, nonpharmacological methods for the treatment of executive dysfunction represent an attractive interventional target. OBJECTIVE To estimate the effect of a structured regular exercise program on neuropsychological domains of executive function in children ages 7 to 12. DATA SOURCES We performed a systematic review of English and non-English articles using Cochrane Library, EBSCO CINAHL, Ovid MEDLINE, PSYCInfo, Pubmed, and Web of Science, including all years allowed by each individual search engine. The search string used was "(exercise OR phys*) AND (cognit* OR executive) AND (child* OR preadolesc*)." The authors of the studies selected for review were contacted for any unpublished data. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, which enrolled children between the ages of 7 and 12, with randomization to either normal activity or a structured physical activity intervention consisting of scheduled aerobic exercise, at least once per week, for a period of at least 1 month. Eligible studies must have included a neuropsychological battery of tests that measured at least 1 executive function both before and after the intervention was completed. STUDY APPRAISAL Two independent reviewers examined the screened studies in detail for potential inclusion. The results of the individual examinations were compared; if any discrepancies were present, a third party analyzed the study to determine if it should be included in the meta-analysis. RESULTS A total of 18 studies were identified by abstract as candidates for inclusion. From these 18 studies, 8 were independently selected by 2 authors for inclusion in the final analysis; there were no selection discrepancies between authors with regard to the studies to be included. In all, 770 subjects were included, 339 in the control group and 431 in the intervention group. All 8 studies contained a measure of inhibitory control; no other domain of executive function was measured frequently enough to perform meta-analysis, so only measures of inhibitory control were pooled and analyzed. A Cohen d effect size was calculated for each measure using the method of Morris for controlled pre-post control measurement studies. The studies were then combined in a random effects model using Comprehensive Meta Analysis software (Biostat, Englewood, NJ) for Windows (Microsoft, Redmond, WA). All studies showed a positive effect of regular exercise with improvements in measures of inhibitory control, but none were statistically significant for this measure. When pooled, the model revealed a combined Cohen d effect size of 0.2 (95% confidence interval, 0.03-0.37; P=0.021), indicating a small improvement of inhibitory control with long-term physical activity. Heterogeneity was very low (I=0). LIMITATIONS Many studies used different neuropsychological tests to assess inhibitory control, which may have introduced unforeseen confounders. Other domains of executive functions were not measured frequently enough to perform meta-analysis. Despite attempts to gather unpublished data, positive results were observed in all of the included studies, raising the possibility of publication bias. CONCLUSIONS AND IMPLICATIONS Increased regular physical activity is associated with a small and measurable, improvement in neuropsychological tests of executive functions, specifically inhibitory control. Executive functions play an important role in complex behavior, and may contribute to academic and career achievement as well as success in social interaction. This finding provides support for the important interaction between exercise and cognitive functioning.
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178
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Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort. Anesthesiology 2017; 127:227-240. [PMID: 28609302 DOI: 10.1097/aln.0000000000001735] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Exposure of young animals to general anesthesia causes neurodegeneration and lasting behavioral abnormalities; whether these findings translate to children remains unclear. This study used a population-based birth cohort to test the hypothesis that multiple, but not single, exposures to procedures requiring general anesthesia before age 3 yr are associated with adverse neurodevelopmental outcomes. METHODS A retrospective study cohort was assembled from children born in Olmsted County, Minnesota, from 1996 to 2000 (inclusive). Propensity matching selected children exposed and not exposed to general anesthesia before age 3 yr. Outcomes ascertained via medical and school records included learning disabilities, attention-deficit/hyperactivity disorder, and group-administered ability and achievement tests. Analysis methods included proportional hazard regression models and mixed linear models. RESULTS For the 116 multiply exposed, 457 singly exposed, and 463 unexposed children analyzed, multiple, but not single, exposures were associated with an increased frequency of both learning disabilities and attention-deficit/hyperactivity disorder (hazard ratio for learning disabilities = 2.17 [95% CI, 1.32 to 3.59], unexposed as reference). Multiple exposures were associated with decreases in both cognitive ability and academic achievement. Single exposures were associated with modest decreases in reading and language achievement but not cognitive ability. CONCLUSIONS These findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention. Although a robust association was observed, these data do not determine whether anesthesia per se is causal.
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179
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Efron D, Vutskits L, Davidson AJ. Can We Really Suggest that Anesthesia Might Cause Attention-deficit/Hyperactivity Disorder? Anesthesiology 2017; 127:209-211. [DOI: 10.1097/aln.0000000000001736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Daryl Efron
- From the Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia (D.E.); Melbourne Children’s Trials Centre (A.J.D.), Murdoch Childrens Research Institute (D.E.), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia (D.E.); Department of Anesthesiology, Pharmacology, and Intensive Care, University Hosp
| | - Laszlo Vutskits
- From the Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia (D.E.); Melbourne Children’s Trials Centre (A.J.D.), Murdoch Childrens Research Institute (D.E.), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia (D.E.); Department of Anesthesiology, Pharmacology, and Intensive Care, University Hosp
| | - Andrew J. Davidson
- From the Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia (D.E.); Melbourne Children’s Trials Centre (A.J.D.), Murdoch Childrens Research Institute (D.E.), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia (D.E.); Department of Anesthesiology, Pharmacology, and Intensive Care, University Hosp
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180
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Fluegge K, Fluegge K. Anesthetic agents, neurodevelopmental risk and the connection to bacterial infections. Microbes Infect 2017; 19:443-448. [PMID: 28666807 DOI: 10.1016/j.micinf.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 11/16/2022]
Abstract
This short communication identifies a significant flaw in research investigating the neurodevelopmental consequences of general anesthesia exposure. We have identified that chronic environmental exposure to pervasive air pollutants that are also widely used as anesthetic agents, specifically nitrous oxide (N2O), may contribute to the rising prevalence of neurodevelopmental disorders. Consistent with the emerging link between microbes and psychiatric illness risk, this epidemiological analysis extends our prior conclusions by proposing that such exposures may alter host immunity so as to enhance vulnerability to certain pathogenic microbes that have been implicated in neurodevelopmental disorders, including Pseudomonas aeruginosa and Clostridium difficile.
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Affiliation(s)
- Keith Fluegge
- Institute of Health and Environmental Research, Cleveland, OH 44118, USA.
| | - Kyle Fluegge
- Institute of Health and Environmental Research, Cleveland, OH 44118, USA; New York City Department of Health and Mental Hygiene, New York 11101-4132, USA
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181
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Ing C, Wall MM, DiMaggio CJ, Whitehouse AJO, Hegarty MK, Sun M, von Ungern-Sternberg BS, Li G, Sun LS. Latent Class Analysis of Neurodevelopmental Deficit After Exposure to Anesthesia in Early Childhood. J Neurosurg Anesthesiol 2017; 29:264-273. [PMID: 27077892 PMCID: PMC5757537 DOI: 10.1097/ana.0000000000000303] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Although some studies have reported an association between early exposure to anesthesia and surgery and long-term neurodevelopmental deficit, the clinical phenotype of children exposed to anesthesia is still unknown. METHODS Data were obtained from the Western Australian Pregnancy Cohort Study (Raine) with neuropsychological tests at age 10 years measuring language, cognition, motor function, and behavior. Latent class analysis of the tests was used to divide the cohort into mutually exclusive subclasses of neurodevelopmental deficit. Multivariable polytomous logistic regression was used to evaluate the association between exposure to surgery and anesthesia and each latent class, adjusting for demographic and medical covariates. RESULTS In our cohort of 1444 children, latent class analysis identified 4 subclasses: (1) Normal: few deficits (n=1135, 78.6%); (2) Language and Cognitive deficits: primarily language, cognitive, and motor deficits (n=96, 6.6%); (3) Behavioral deficits: primarily behavioral deficits, (n=151, 10.5%); and (4) Severe deficits: deficits in all neuropsychological domains (n=62, 4.3%). Language and cognitive deficit group children were more likely to have exposure before age 3 (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.17-3.81), whereas a difference in exposure was not found between Behavioral or Severe deficit children (aOR, 1.00; 95% CI, 0.58-1.73, and aOR, 0.85; 95% CI, 0.34-2.15, respectively) and Normal children. CONCLUSIONS Our results suggest that in evaluating children exposed to surgery and anesthesia at an early age, the phenotype of interest may be children with deficits primarily in language and cognition, and not children with broad neurodevelopmental delay or primarily behavioral deficits.
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Affiliation(s)
- Caleb Ing
- Departments of *Anesthesiology ††Anesthesiology and Pediatrics, Columbia University College of Physicians and Surgeons Departments of †Psychiatry and Biostatistics ‡Anesthesiology and Epidemiology ¶Anesthesiology and Biostatistics **Anesthesiology and Epidemiology, Columbia University College of Physicians and Surgeons and Mailman School of Public Health, New York, NY §Telethon Kids Institute #School of Medicine and Pharmacology, The University of Western Australia ∥Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
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182
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Wang Y, Han S, Han R, Su Y, Li J. Propofol-induced downregulation of NR2B membrane translocation in hippocampus and spatial memory deficits of neonatal mice. Brain Behav 2017; 7:e00734. [PMID: 28729940 PMCID: PMC5516608 DOI: 10.1002/brb3.734] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/10/2017] [Accepted: 04/21/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thousands of infants and children are undergoing anesthesia around the world every day. But impacts of anesthetics on the developing neural system remain unclear yet. Previous evidence showed that anesthesia might affect the developing neural system. Thus, early-life anesthesia becomes a critical issue in clinical pediatric practice. Hence, propofol, a short-acting and widely applied intravenous anesthetic, has been gaining focus upon neonatal anesthesia. METHODS Fifty-four male C57BL/6J mice were randomly divided into following three groups: group D6 intraperitoneally (i.p.) injected propofol (100 mg/kg body weight) once a day from postnatal day 6 (P6) to P11, group D1 administrated propofol (100 mg/kg, i.p.) at P6 solely and administrated normal saline (10 ml/kg, i.p.) from P7 to P11, and group N treated with normal saline (10 ml/kg, i.p.) from P6 to P11 as the control (n = 18 per group). Then, at P28, nine mice were collected randomly from each group for NR2B membrane translocation and phosphorylation analysis, and the rest half in each group were assigned to perform Morris water maze tests from P28 to P35. RESULTS Results showed that total protein expression levels of NR2B increased (p < .001) while its membrane translocation decreased (p < .001, n = 9 per group) in the hippocampus but not in the prefrontal cortex of neonatal mice after repeated propofol administration. Phosphorylation levels of NR2B at serine 1303 (D1: p < .05; D6: p < .001, n = 9 per group) and serine 1480 (D1: p < .01, D6: p < .001, n = 9 per group) increased significantly as well in the hippocampus compared with group N. In addition, memory deficits (p < .05, n = 9 per group) were observed in Morris water maze tests of group D6 mice. CONCLUSIONS These results suggested that propofol exposure downregulates NR2B membrane translocation and causes spatial memory deficits, with a mediated increased NR2B protein expression and phosphorylation at Ser1303/1480 residues in the hippocampus of neonatal mice.
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Affiliation(s)
- Yuzhu Wang
- Department of Anesthesiology Beijing Shijitan Hospital Capital Medical University Beijing China
| | - Song Han
- Department of Neurobiology and Center of Stroke Beijing Institute for Brain Disorders Capital Medical University Beijing China
| | - Ruquan Han
- Department of Anesthesiology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Yue Su
- Department of Anesthesiology Beijing Shijitan Hospital Capital Medical University Beijing China
| | - Junfa Li
- Department of Neurobiology and Center of Stroke Beijing Institute for Brain Disorders Capital Medical University Beijing China
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183
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Recent Insights Into Molecular Mechanisms of Propofol-Induced Developmental Neurotoxicity: Implications for the Protective Strategies. Anesth Analg 2017; 123:1286-1296. [PMID: 27551735 DOI: 10.1213/ane.0000000000001544] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Mounting evidence has demonstrated that general anesthetics could induce developmental neurotoxicity, including acute widespread neuronal cell death, followed by long-term memory and learning abnormalities. Propofol is a commonly used intravenous anesthetic agent for the induction and maintenance of anesthesia and procedural and critical care sedation in children. Compared with other anesthetic drugs, little information is available on its potential contributions to neurotoxicity. Growing evidence from multiple experimental models showed a similar neurotoxic effect of propofol as observed in other anesthetic drugs, raising serious concerns regarding pediatric propofol anesthesia. The aim of this review is to summarize the current findings of propofol-induced developmental neurotoxicity. We first present the evidence of neurotoxicity from animal models, animal cell culture, and human stem cell-derived neuron culture studies. We then discuss the mechanism of propofol-induced developmental neurotoxicity, such as increased cell death in neurons and oligodendrocytes, dysregulation of neurogenesis, abnormal dendritic development, and decreases in neurotrophic factor expression. Recent findings of complex mechanisms of propofol action, including alterations in microRNAs and mitochondrial fission, are discussed as well. An understanding of the toxic effect of propofol and the underlying mechanisms may help to develop effective novel protective or therapeutic strategies for avoiding the neurotoxicity in the developing human brain.
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184
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Behavioral regression in 2 patients with autism spectrum disorder and attention-deficit/hyperactivity disorder after oral surgery performed with a general anesthetic. J Am Dent Assoc 2017; 148:519-524. [PMID: 28651707 DOI: 10.1016/j.adaj.2017.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OVERVIEW Routine dental care for people with autism spectrum disorders can be complex. There is little published on postoperative behavioral changes associated with use of general anesthetics in this population. CASE DESCRIPTION The authors describe postoperative behavioral changes in 2 patients with autism spectrum disorder and attention deficit hyperactivity disorder that the patients' caretakers described as regression. In both cases, behaviors representative of autism spectrum disorder and attention deficit hyperactivity disorder worsened after uncomplicated oral surgery after receipt of a general anesthetic in the operating room. In both cases, behavioral changes caused great difficulties for the patients and caretakers and were difficult to address. CONCLUSIONS AND PRACTICAL IMPLICATIONS With little in the scientific literature, these 2 cases have a great importance for the dental care practitioner. Awareness must be raised so that further investigation can occur regarding this phenomenon.
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185
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Álvarez Escudero J, Paredes Esteban RM, Cambra Lasaosa FJ, Vento M, López Gil M, de Agustín Asencio JC, Moral Pumarega MT. More than 3 hours and less than 3 years old. Safety of anesthetic procedures in children under 3 years of age, subject to surgeries of more than 3 hours. ACTA ACUST UNITED AC 2017. [PMID: 28641810 DOI: 10.1016/j.redar.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J Álvarez Escudero
- Presidente de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), jefe del Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, catedrático de Anestesiología, director del Departamento de Cirugía y especialidades Médico Quirúrgicas, Facultad de Medicina y Odontología, Universidad de Santiago de Compostela.
| | - R M Paredes Esteban
- Presidente de la Sociedad Española de Cirugía Pediátrica (SECP), presidente de la Sociedad Andaluza de Cirugía Pediátrica (ACPA), directora de la Unidad de Gestión Clínica de Cirugía Pediátrica, jefa del Servicio de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España
| | - F J Cambra Lasaosa
- Presidente de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), jefe del Servicio Unidad de Cuidados Intensivos Pediátricos Hospital Universitario Sant Joan de Déu, Barcelona, profesor asociado de Pediatría, Facultad de Medicina, Universidad de Barcelona
| | - M Vento
- Presidente de la Sociedad Española de Neonatología (SENeo), coordinador nacional de la Retic, Red de Salud Materno Infantil y del Desarrollo SAMID RD16/0022, Instituto Carlos III, Ministerio de Economía, Industria y Competitividad, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M López Gil
- Vicepresidenta de la Sección Anestesia Pediátrica, Sociedad Española de Anestesiología Reanimación y Terapéutica del Dolor (SEDAR), jefa del Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, profesora asociada del Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid
| | - J C de Agustín Asencio
- Vicepresidente de la Sociedad Española de Cirugía Pediátrica (SECP), jefe del Servicio de Cirugía Pediátrica, coordinador de Especialidades Quirúrgicas en Pediatría, Hospital Materno Infantil, Hospital General Universitario Gregorio Marañón, Madrid, profesor asociado de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid
| | - M T Moral Pumarega
- Sociedad Española de Neonatología (SENeo), jefa de Sección, Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, colaboradora de la REDSAMID, profesora asociada de Pediatría y Ciencias de la Salud, Facultad de Medicina, Universidad Complutense de Madrid
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186
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Isoflurane Anesthesia Has Long-term Consequences on Motor and Behavioral Development in Infant Rhesus Macaques. Anesthesiology 2017; 126:74-84. [PMID: 27749311 DOI: 10.1097/aln.0000000000001383] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Experimental evidence correlates anesthetic exposure during early development with neuronal and glial injury and death, as well as behavioral and cognitive impairments, in young animals. Several, although not all, retrospective human studies of neurocognitive and behavioral disorders after childhood exposure to anesthesia suggest a similar association. Few studies have specifically investigated the effects of infant anesthesia exposure on subsequent neurobehavioral development. Using a highly translational nonhuman primate model, the authors investigated the potential dose-dependent effects of anesthesia across the first year of development. METHODS The authors examined the effects of single or multiple early postnatal isoflurane exposures on subsequent behavioral development in 24 socially reared rhesus macaques. Infants were exposed to 5 h of isoflurane anesthesia once, three times (ISO-3), or not at all (control). The authors assessed reflex development and anxiety using standardized tests. At approximately 1 yr, infants (n = 23) were weaned and housed indoors with 5 to 6 other subjects. The authors recorded their response to this move and reassessed anxiety. RESULTS Compared to controls, animals exposed to repeated isoflurane (ISO-3) presented with motor reflex deficits at 1 month (median [range]: ISO-3 = 2 [1 to 5] vs. control = 5 [3 to 7]; P < 0.005) and responded to their new social environment with increased anxiety (median [range]: ISO-3 = 0.4 bouts/min [0.2 to 0.6]; control = 0.25 bouts/min [0.1 to 0.3]; P = 0.05) and affiliative/appeasement behavior (median [range]: ISO-3 = 0.1 [0 to 0.2]; control = 0 bouts/min [0 to 0.1]; P < 0.01) at 12 months. There were no statistically significant behavioral alterations after single isoflurane exposure. CONCLUSIONS Neonatal exposure to isoflurane, particularly when repeated, has long-term behavioral consequences affecting both motor and socioemotional aspects of behavior.
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A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics. J Anesth 2017; 31:764-778. [PMID: 28585095 PMCID: PMC5640726 DOI: 10.1007/s00540-017-2375-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/20/2017] [Indexed: 12/20/2022]
Abstract
A large number of studies during the past two decades have demonstrated the efficacy and safety of sevoflurane across patient populations. Clinical researchers have also investigated the effects of sevoflurane, its hemodynamic characteristics, its potential protective effects on several organ systems, and the incidence of delirium and cognitive deficiency. This review examines the clinical profiles of sevoflurane and other anesthetic agents, and focuses upon emerging topics such as organ protection, postoperative cognitive deficiency and delirium, and novel ways to improve postanesthesia outcomes.
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188
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Anesthesia, brain changes, and behavior: Insights from neural systems biology. Prog Neurobiol 2017; 153:121-160. [PMID: 28189740 DOI: 10.1016/j.pneurobio.2017.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 02/08/2023]
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189
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TNF-α Mediates the Intrinsic and Extrinsic Pathway in Propofol-Induced Neuronal Apoptosis Via PI3K/Akt Signaling Pathway in Rat Prefrontal Cortical Neurons. Neurotox Res 2017; 32:409-419. [DOI: 10.1007/s12640-017-9751-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 12/26/2022]
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190
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Effect of General Anesthesia on Neurodevelopmental Abnormalities in Children Undergoing Treatment of Vascular Anomalies With Laser Surgery: A Retrospective Review. Dermatol Surg 2017; 43:534-540. [PMID: 28033152 DOI: 10.1097/dss.0000000000001003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Multiple exposures to general anesthesia may be neurotoxic to the developing brain. This relationship has not been evaluated in children undergoing laser surgery for vascular anomalies. OBJECTIVE To evaluate the prevalence of neurodevelopmental abnormalities in children who received multiple laser procedures under general anesthesia before the age of 4 years for the treatment of vascular anomalies. METHODS AND MATERIALS Retrospective chart review of patients with contact of parents for telephone interview. RESULTS Thirty-three patients were eligible. Average age at the time of survey was 7.8 years. Twenty-three (84.8%) patients were female, with average age at the time of first treatment at 1.9 years. Average number of treatments received before the age of 4 years was 6.7. Anesthetics included inhalational nitrous oxide and isoflurane and intravenous propofol. Seven patients carried one or more of the following diagnoses: attention-deficit hyperactivity disorder (3.0%), anxiety (6.1%), behavioral disorder (3.0%), language disorder (3.0%), speech disorder (3.0%), and motor disorder (6.1%). These prevalence rates are similar to those found in the US population. CONCLUSION This is the first report on the prevalence of neurodevelopmental disorders in children undergoing multiple laser treatments under general anesthesia. Although the study sample is small, no increased risks when comparing with prevalence rates reported in the literature were noted.
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Application of advanced preclinical models and methods in anesthetic neurotoxicity research. Neurotoxicol Teratol 2017; 61:1-6. [DOI: 10.1016/j.ntt.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 01/12/2023]
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Bjur KA, Payne ET, Nemergut ME, Hu D, Flick RP. Anesthetic-Related Neurotoxicity and Neuroimaging in Children: A Call for Conversation. J Child Neurol 2017; 32:594-602. [PMID: 28424007 PMCID: PMC5407309 DOI: 10.1177/0883073817691696] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Each year millions of young children undergo procedures requiring sedation or general anesthesia. An increasing proportion of the anesthetics used are provided to optimize diagnostic imaging studies such as magnetic resonance imaging. Concern regarding the neurotoxicity of sedatives and anesthetics has prompted the US Food and Drug Administration to change labeling of anesthetics and sedative agents warning against repeated or prolonged exposure in young children. This review aims to summarize the risk of anesthesia in children with an emphasis on anesthetic-related neurotoxicity, acknowledge the value of pediatric neuroimaging, and address this call for conversation.
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Affiliation(s)
- Kara A Bjur
- 1 Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric T Payne
- 2 Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Danqing Hu
- 4 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Randall P Flick
- 3 Division of Pediatric Anesthesiology, Mayo Clinic, Rochester, MN, USA
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Milanovic D, Pesic V, Loncarevic-Vasiljkovic N, Avramovic V, Tesic V, Jevtovic-Todorovic V, Kanazir S, Ruzdijic S. Neonatal Propofol Anesthesia Changes Expression of Synaptic Plasticity Proteins and Increases Stereotypic and Anxyolitic Behavior in Adult Rats. Neurotox Res 2017; 32:247-263. [DOI: 10.1007/s12640-017-9730-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
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194
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Broad KD, Kawano G, Fierens I, Rocha-Ferreira E, Hristova M, Ezzati M, Rostami J, Alonso-Alconada D, Chaban B, Hassell J, Fleiss B, Gressens P, Sanders RD, Robertson NJ. Surgery increases cell death and induces changes in gene expression compared with anesthesia alone in the developing piglet brain. PLoS One 2017; 12:e0173413. [PMID: 28355229 PMCID: PMC5371291 DOI: 10.1371/journal.pone.0173413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/19/2017] [Indexed: 11/24/2022] Open
Abstract
In a range of animal species, exposure of the brain to general anaesthesia without surgery during early infancy may adversely affect its neural and cognitive development. The mechanisms mediating this are complex but include an increase in brain cell death. In humans, attempts to link adverse cognitive development to infantile anaesthesia exposure have yielded ambiguous results. One caveat that may influence the interpretation of human studies is that infants are not exposed to general anaesthesia without surgery, raising the possibility that surgery itself, may contribute to adverse cognitive development. Using piglets, we investigated whether a minor surgical procedure increases cell death and disrupts neuro-developmental and cognitively salient gene transcription in the neonatal brain. We randomly assigned neonatal male piglets to a group who received 6h of 2% isoflurane anaesthesia or a group who received an identical anaesthesia plus 15 mins of surgery designed to replicate an inguinal hernia repair. Compared to anesthesia alone, surgery-induced significant increases in cell death in eight areas of the brain. Using RNAseq data derived from all 12 piglets per group we also identified significant changes in the expression of 181 gene transcripts induced by surgery in the cingulate cortex, pathway analysis of these changes suggests that surgery influences the thrombin, aldosterone, axonal guidance, B cell, ERK-5, eNOS and GABAA signalling pathways. This suggests a number of novel mechanisms by which surgery may influence neural and cognitive development independently or synergistically with the effects of anaesthesia.
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MESH Headings
- Aldosterone/genetics
- Aldosterone/metabolism
- Anesthesia, General/adverse effects
- Anesthetics, Inhalation/administration & dosage
- Anesthetics, Inhalation/adverse effects
- Animals
- Animals, Newborn
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- Cell Death/drug effects
- Gene Expression Profiling
- Gene Expression Regulation, Developmental/drug effects
- Gyrus Cinguli/drug effects
- Gyrus Cinguli/metabolism
- Gyrus Cinguli/pathology
- Hernia, Inguinal/complications
- Hernia, Inguinal/surgery
- Herniorrhaphy/adverse effects
- Isoflurane/administration & dosage
- Isoflurane/adverse effects
- Male
- Mitogen-Activated Protein Kinase 7/genetics
- Mitogen-Activated Protein Kinase 7/metabolism
- Nerve Net/drug effects
- Nerve Net/metabolism
- Nerve Net/pathology
- Nitric Oxide Synthase Type III/genetics
- Nitric Oxide Synthase Type III/metabolism
- Receptors, GABA-A/genetics
- Receptors, GABA-A/metabolism
- Sequence Analysis, RNA
- Signal Transduction
- Swine
- Thrombin/genetics
- Thrombin/metabolism
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Affiliation(s)
- Kevin D. Broad
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Go Kawano
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Igor Fierens
- Institute for Women’s Health, University College London, London, United Kingdom
| | | | - Mariya Hristova
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Mojgan Ezzati
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Jamshid Rostami
- Institute for Women’s Health, University College London, London, United Kingdom
| | | | - Badr Chaban
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Jane Hassell
- Institute for Women’s Health, University College London, London, United Kingdom
| | - Bobbi Fleiss
- Centre for the Developing Brain, Kings College, St Thomas Campus, London, United Kingdom
- Inserm, U1141, Paris, France
- University Paris Diderot, Sorbonne Paris Cite, UMRS 1141, Paris, France
| | - Pierre Gressens
- Centre for the Developing Brain, Kings College, St Thomas Campus, London, United Kingdom
- Inserm, U1141, Paris, France
- University Paris Diderot, Sorbonne Paris Cite, UMRS 1141, Paris, France
| | - Robert D. Sanders
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Nicola J. Robertson
- Institute for Women’s Health, University College London, London, United Kingdom
- * E-mail:
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Almenrader N, Colucci P, De Castro V, Valeri D, Palmery M, Trezza V, Campolongo P. Effects of sevoflurane and clonidine on acid base status and long-term emotional and cognitive outcomes in spontaneously breathing rat pups. PLoS One 2017; 12:e0173969. [PMID: 28319126 PMCID: PMC5358762 DOI: 10.1371/journal.pone.0173969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background Numerous experiments in rodents suggest a causative link between exposure to general anaesthetics during brain growth spurt and poor long-lasting neurological outcomes. Many of these studies have been questioned with regard of their translational value, mainly because of extremely long anaesthesia exposure. Therefore, the aim of the present study was to assess the impact of a short sevoflurane anaesthesia, alone or combined with clonidine treatment, on respiratory function in spontaneously breathing rat pups and overall effects on long-lasting emotional and cognitive functions. Methods At postnatal day (PND) 7, male Sprague Dawley rat pups were randomized into four groups and exposed to sevoflurane for one hour, to a single dose of intraperitoneal clonidine or to a combination of both and compared to a control group. Blood gas analysis was performed at the end of sevoflurane anaesthesia and after 60 minutes from clonidine or saline injection. Emotional and cognitive outcomes were evaluated in different group of animals at infancy (PND12), adolescence (PND 30–40) and adulthood (PND 70–90). Results Rat pups exposed to either sevoflurane or to a combination of sevoflurane and clonidine developed severe hypercapnic acidosis, but maintained normal arterial oxygenation. Emotional and cognitive outcomes were not found altered in any of the behavioural task used either at infancy, adolescence or adulthood. Conclusions Sixty minutes of sevoflurane anaesthesia in newborn rats, either alone or combined with clonidine, caused severe hypercapnic acidosis in spontaneously breathing rat pups, but was devoid of long-term behavioural dysfunctions in the present setting.
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Affiliation(s)
- Nicole Almenrader
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
- Department of Anaesthesia and Intensive Care, Policlinico Umberto I, Rome, Italy
| | - Paola Colucci
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Valentina De Castro
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Daniela Valeri
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Viviana Trezza
- Department of Science, Section of Biomedical Sciences and Technologies, University “Roma Tre”, Rome, Italy
| | - Patrizia Campolongo
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
- * E-mail:
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Abstract
Over a decade ago, alarming findings were reported that exposure of the very young and very old animals to clinically used general anesthetics could be detrimental to their brains. The evidence presented suggested that the exposure to commonly used gaseous and intravenous general anesthetics induces the biochemical and morphologic changes in the immature and aging neurons ultimately resulting in their demise. More alarming was the demonstration of significant cognitive and behavioral impairments noted long after the initial anesthesia exposure. This article provides an overview of anesthesia-induced developmental neurotoxicity and commentary on the effects of general anesthesia on the aging brain.
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Affiliation(s)
- Vesna Jevtovic-Todorovic
- Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B-113, Leprino Office Building 7th Floor, 12401 East 17th Avenue, Aurora, CO 80045, USA.
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197
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Regional block via continuous caudal infusion as sole anesthetic for inguinal hernia repair in conscious neonates. Pediatr Surg Int 2017; 33:341-345. [PMID: 27873010 DOI: 10.1007/s00383-016-4027-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The use of general anesthesia in young children has come under increasing scrutiny due to its potential long-term neurotoxic effects. Meanwhile, regional anesthesia for surgical procedures in neonates has many advantages, including preservation of respiratory status and faster return to feeding. We describe the successful use of 3% 2-chloroprocaine administered via continuous caudal infusion as the sole anesthetic agent during elective surgical procedures in infants. METHODS A retrospective chart review of all patients who underwent elective surgical procedures under continuous caudal regional anesthetic at a single institution was performed. Thirty patients (27 males, three females) were identified: 28 patients underwent inguinal hernia repairs. Caudal anesthesia was established via continuous infusion of 3% 2-chloroprocaine through an indwelling catheter. RESULTS Successful analgesia by regional block alone was achieved in all patients for the duration of each surgical procedure without need for rescue anesthesia. Mean operative time was 49 min. Patients were able to return to feeding immediately after surgery and were ready for discharge home within that day. CONCLUSION Continuous caudal infusion of chloroprocaine is a safe and effective way to maintain adequate analgesia for elective surgeries in infants. This successful regional approach obviates the use of general anesthetic which reduces post-operative recovery time and avoids concerns for neurotoxicity.
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198
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Neurological injury in paediatric cardiac surgery. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-016-0481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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199
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Card EB, Wells NL. An Introduction to the Smart Tots Consensus Statement on the Use of Anesthetic and Sedative Drugs in Infants and Toddlers. J Perianesth Nurs 2017; 31:3-10. [PMID: 26847775 DOI: 10.1016/j.jopan.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Li CX, Zhang X. Effects of Long-Duration Administration of 1% Isoflurane on Resting Cerebral Blood Flow and Default Mode Network in Macaque Monkeys. Brain Connect 2017; 7:98-105. [PMID: 28030956 DOI: 10.1089/brain.2016.0445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Isoflurane is an inhalational anesthetic that is widely used in medical procedures or biomedical research. The duration of anesthesia administration varies from minutes to hours. It is known that isoflurane has dose-dependent effects on brain functionality and physiology, and long-duration anesthesia administration could cause neurocognitive decline in animals and humans. However, the duration effect of isoflurane on the brain physiology and functionality still remains poorly understood. In the present study, cerebral blood flow (CBF) and functional connectivity of adult rhesus monkeys (maintained with 1% isoflurane for 4 h) were examined by using magnetic resonance imaging. The results demonstrate that long-duration isoflurane exposure could result in CBF reduction in most brain areas and functional connectivity decrease in the dominant default-mode network. This study reveals the anesthetic duration effects in the central nervous system of anesthetized subjects and suggests that such duration effects should be considered in examining the brain function of anesthetized animals or humans with contemporary neuroimaging approaches.
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Affiliation(s)
- Chun-Xia Li
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University , Atlanta, Georgia
| | - Xiaodong Zhang
- 1 Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University , Atlanta, Georgia .,2 Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University , Atlanta, Georgia
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