miércoles, 3 de enero de 2018

Anestesia general y desarrollo cerebral en niños / General anesthesia and pediatric brain development

Enero 3, 2018. No. 2952
La anestesia general de larga duración influye en la inteligencia de los niños en edad escolar.
Long-duration general anesthesia influences the intelligence of school age children.
BMC Anesthesiol. 2017 Dec 19;17(1):170. doi: 10.1186/s12871-017-0462-8.
BACKGROUND: General anesthesia has been linked to impaired brain development in immature animals and young children. In this study the influence of orthopedic surgery under general anesthesia on the intelligence of school age children has been evaluated.  CONCLUSIONS: More than 3 h general anesthesia influenced the IQ of school age children for up to 3 months after orthopedic surgery. Beside extended exposure time to anesthetics additional factors for post-operative IQ reduction were younger children age, mothers with low educational levels and premature birth.
TRIAL REGISTRATION: Chinese Clinical Trial Registry with registration number ChiCTR-OOC-17013497  retrospectively registered on 11/23/2017.
KEYWORDS: Children; Cognition; General anesthesia; Intelligence; Orthopedic surgery
Efectos de la anestesia en el cerebro en desarrollo. Infantes y fetos
Effect of Anesthesia on the Developing Brain: Infant and Fetus.
Fetal Diagn Ther. 2017 Jun 7. doi: 10.1159/000475928. [Epub ahead of print]
The potential for commonly used anesthetics and sedatives to cause neuroapoptosis and other neurodegenerative changes in the developing mammalian brain has become evident in animal studies over the past 15 years. This concern has led to a number of retrospective studies in human infants and young children, and some of these studies observed an association between exposure to general anesthesia as an infant, and later neurobehavioral problems in childhood. This association is particularly evident for prolonged or repeated exposures. Because of the significant growth of fetal interventions requiring sedation and analgesia for the fetus, or because of maternal anesthetic effects, this concern about anesthetic neurotoxicity is relevant for the fetus. The potential for anesthetic neurotoxicity is the most important clinical and research problem in the field of pediatric anesthesiology. This review will first briefly summarize the rapid brain growth and development in the fetus and neonate. Next, animal model data of anesthetic neurotoxicity in the fetus and neonate will be presented, followed by a review of recent human clinical anesthetic neurotoxicity trials. Finally, the rationale for studying dexmedetomidine as a potential neuroprotectant agent in anesthetic neurotoxicity will be reviewed along with study design for two human clinical trials involving dexmedetomidine.
KEYWORDS: Anesthetic neurotoxicity; Dexmedetomidine; Fetus; Isoflurane; Neonate; Sevoflurane
Efectos de la anestesia sobre el desarrollo cerebral de los niños
Effects of Anesthesia on Children's Brain Development
Hernández-Cortez Enrique
J Anesth Crit Care Open Access 2015, 2(6): 00079
Nowadays, the administration of most of the anesthetics is being questioned. The quality of reversibility of these medications is being questioned, especially when administered to children under 3 years old. The administration of isoflurane elevates intracellular calcium levels which are critical for cell damage resulting in apoptosis. The NMDA and GABA receptors are indirectly involved in the effect of immature brains. The immaturity of the central nervous system associated to the administration of anesthetic agents such as inhaled anesthetics, ketamine, midazolam, nitrous oxide, and others, produces important changes in the brain that have an impact in the child's later life. There are two important elements in the neurotoxicity of anesthetics, dosage and time administration. Repeating anesthetics produces more brain changes. These modifications have resulted in serious behavioral and memory changes in experiments in animals. It is suspected that a similar situation may arise in children who manifest learning disabilities in later stages. 
Keywords: Apoptosis; Anesthetics; Children

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