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Does pediatric anesthesia cause brain damage? - Addressing parental and provider concerns in light of compelling animal studies and seemingly ambivalent human data.

Authors
 Jeong-Rim Lee  ;  Andreas W. Loepke 
Citation
 KOREAN JOURNAL OF ANESTHESIOLOGY, Vol.71(4) : 255-273, 2018 
Journal Title
 KOREAN JOURNAL OF ANESTHESIOLOGY 
ISSN
 2005-6419 
Issue Date
2018
Keywords
Animal experimentation ; Apoptosis ; Brain injuries ; Cognitive dysfunction ; Infant ; Neonate ; Anesthesia
Abstract
Anesthesia facilitates surgery in millions of young children every year. Structural brain abnormalities and functional impairment observed in animals have created substantial concerns among clinicians, parents, and government regulators. Clinical studies seemed ambivalent; it remains unclear whether differential species effects exist towards anesthetic exposure. The current literature search and analysis attempts to unify the available clinical and animal studies, which currently comprise of > 530 in vivo animal studies and > 30 clinical studies. The prevalence of abnormalities was lowest for exposures < 1 hour, in both animals and humans, while studies with injurious findings increased in frequency with exposure time. Importantly, no exposure time, anesthetic technique, or age during exposure was clearly identifiable to be entirely devoid of any adverse outcomes. Moreover, the age dependence of maximum injury clearly identified in animal studies, combined with the heterogeneity in age in most human studies, may impede the discovery of a specific human neurological phenotype. In summary, animal and human research studies identify a growing prevalence of injurious findings with increasing exposure times. However, the existing lack of definitive data regarding safe exposure durations, unaffected ages, and non-injurious anesthetic techniques precludes any evidence-based recommendations for drastically changing current clinical anesthesia management. Animal studies focusing on brain maturational states more applicable to clinical practice, as well as clinical studies focusing on prolonged exposures during distinct developmental windows of vulnerability, are urgently needed to improve the safety of perioperative care for thousands of young children requiring life-saving and quality of life-improving procedures daily.
DOI
10.4097/kja.d.18.00165
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jeong Rim(이정림) ORCID logo https://orcid.org/0000-0002-7425-0462
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165355
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