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Influence of general anesthetic exposure in developing brain on cognition and the underlying mechanisms

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Author:: No author available

Journal Title:: Acta Physiologica Sinica

Issue:: 5

DOI:: 10.13294/j.aps.2019.0048

Key Word:: 全身麻醉药;脑发育;认知;影响;机制

Abstract：随着医疗技术的进步,各类先进设备、检测手段不断增加,通过手术或其他有创方式救治的疾病谱不断增加.越来越多的婴幼儿需要接受全身麻醉药(全麻药)麻醉进行临床检查或治疗,而全麻药是否对仍处在发育期的婴幼儿脑结构和功能(如认知)产生影响是一个重要、复杂而又有争议的问题,因而受到神经生物学、麻醉学和儿科学等领域学者的高度关注.人群调查结果证实,发育期短期单次全麻药暴露对认知功能的影响较弱,多次全麻药暴露则会对认知功能造成损伤.基于动物的研究进一步揭示了发育期全麻药暴露的损伤机制.全麻药暴露的时间点较麻醉时长更关键,突触形成高峰期最易受全麻药损伤:在突触形成高峰期,全麻药暴露可诱导胞内钙超载、线粒体损伤、能量代谢失衡,损伤细胞功能;启动细胞凋亡,诱导过度自噬,导致细胞丢失;抑制突触相关蛋白的表达,突触形成受损,干扰突触传递过程及可塑性,影响神经环路和脑区功能活动.因此,细胞损伤、细胞丢失和神经环路功能受损构成发育期全麻药暴露损伤认知功能的重要机制.此外,有研究应用高通量组学技术对全麻药暴露引起的差异表达基因进行了初步筛选,为深入研究全麻药损伤的基因表达及调控机制提供了新思路.本文从整体行为学、神经元网络、细胞损伤、基因表达及调控和脑功能代谢等方面对发育期全麻药暴露影响认知功能及相关机制的研究进展进行综述,希望能为临床婴幼儿全麻方案的制定提供理论依据.

Reference

[1]Sabina Rizzi,Carlo Ori,Vesna Jevtovic-Todorovic.Timing versus duration Determinants of anesthesia-induced developmental apoptosis in the young mammalian brain[C].2008.
[2]Qiu, Lin,Zhu, Changlian,Bodogan, Timea,etc.Acute and Long-Term Effects of Brief Sevoflurane Anesthesia During the Early Postnatal Period in Rats[J].2016,149(1).
[3]George K, Istaphanous,Jennifer, Howard,Xinyu, Nan,etc.Comparison of the neuroapoptotic properties of equipotent anesthetic concentrations of desflurane, isoflurane, or sevoflurane in neonatal mice.[J].2011,114.
[4]Chainllie Young,Vesna Jevtovic-Todorovic,Yue-Qin Qin,etc.Potential of ketamine and midazolam, individually or in combination, to induce apoptotic neurodegeneration in the infant mouse brain[J].2005,146(2).
[5]Chan,DC.Mitochondrial fusion and fission in mammals.[J].2006,22.
[6]Zheng, Hui,Dong, Yuanlin,Xu, Zhipeng,etc.Sevoflurane Anesthesia in Pregnant Mice Induces Neurotoxicity in Fetal and Offspring Mice[J].2013,118(3).
[7]Gongyi, Ren,Yachun, Zhou,Ge, Liang,etc.General Anesthetics Regulate Autophagy via Modulating the Inositol 1,4,5-Trisphosphate Receptor: Implications for Dual Effects of Cytoprotection and Cytotoxicity.[J].2017,7(1).
[8]Vutskits L.Developmental Stage-dependent Persistent Impact of Propofol Anesthesia on Dendritic Spines in the Rat Medial Prefrontal Cortex.[J].2011,115(2).
[9]Martin, L. D.,Dissen, G. A.,McPike, M. J.,etc.Effects of anesthesia with isoflurane, ketamine, or propofol on physiologic parameters in neonatal rhesus macaques (Macaca mulatta).[J].2014,53(3).
[10]Wang C,Zou X,Patterson TA,etc.Potential neurotoxicity of ketamine in the developing rat brain.[J].2009,108(1).
[11]Brambrink,A.M.,Back,S.A.,Riddle,A.,etc.Isoflurane-induced apoptosis of oligodendrocytes in the neonatal primate brain[J].2012,72(4).
[12]Vesna, Jevtovic-Todorovic,A, Boscolo,V, Sanchez,etc.Anesthesia-induced developmental neurodegeneration: the role of neuronal organelles.[J].2012,3.
[13]Peterson BS,Tau GZ.Normal development of brain circuits.[J].2010,35(1).
[14]Warner, David O.,Zaccariello, Michael J.,Katusic, Slavica K.,etc.Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia The Mayo Anesthesia Safety in Kids (MASK) Study[J].2018,129(1).
[15]H. NIKIZAD,J-H. YON,V. JEVTOVIC-TODOROVIC,etc.Early Exposure to General Anesthesia Causes Significant Neuronal Deletion in the Developing Rat Brain[J].2008,1122(0).
[16]Lena S, Sun,Guohua, Li,Tonya L K, Miller,etc.Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood.[J].2016.
[17]Andropoulos, Dean B.,Greene, Michael F..Anesthesia and Developing Brains - Implications of the FDA Warning[J].2017,376(10).
[18]Michele L,Schaefer,Meina,Wang,Patric J,Perez,etc.Nitric Oxide Donor Prevents Neonatal Isoflurane-induced Impairments in Synaptic Plasticity and Memory.[J].2018.
[19]Noguchi, K. K.,Johnson, S. A.,Dissen, G. A.,etc.Isoflurane exposure for three hours triggers apoptotic cell death in neonatal macaque brain[J].2017,119(3).
[20]Chen Q,Eckenhoff MF,Joseph DJ,etc.Anesthetic-induced neurodegeneration mediated via inositol 1,4,5-trisphosphate receptors.[J].2010,333(1).
[21]Ponten SC,Reijneveld JC,Stam CJ,etc.The application of graph theoretical analysis to complex networks in the brain.[J].2007,118(11).
[22]Lunardi N,Ori C,Erisir A,etc.General anesthesia causes long-lasting disturbances in the ultrastructural properties of developing synapses in young rats.[J].2010,17(2).
[23]Glatz, Pia,Sandin, Rolf H.,Pedersen, Nancy L.,etc.Association of Anesthesia and Surgery During Childhood With Long-term Academic Performance[J].2017,171(1).
[24]Johnson SA,Olney JW,Young C.Isoflurane-induced neuroapoptosis in the developing brain of nonhypoglycemic mice.[J].2008,20(1).
[25]Boscolo,A.,Milanovic,D.,Starr,J.A.,etc.Early exposure to general anesthesia disturbs mitochondrial fission and fusion in the developing rat brain[J].2013,118(5).
[26]Douglas L Rothman,Zvi Jacob,Hedok Lee,etc.Metabolomic Profiling of Children's Brains Undergoing General Anesthesia with Sevoflurane and Propofol[J].2012,117(5).
[27]Berridge MJ.Inositol trisphosphate and calcium signalling mechanisms.[J].2009,1793(6).
[28]Evers AS,Avidan MS,Dissen GA,etc.Ketamine-induced neuroapoptosis in the fetal and neonatal rhesus macaque brain.[J].2012,116(2).
[29]TAO HAN,ZHONGHUA HU,YONGZHONG TANG,etc.Inhibiting Rho kinase 2 reduces memory dysfunction in adult rats exposed to sevoflurane at postnatal days 7-9.[J].2015,3(3).
[30]Joksovic, Pavle M.,Lunardi, Nadia,Jevtovic-Todorovic, Vesna,etc.Early Exposure to General Anesthesia with Isoflurane Downregulates Inhibitory Synaptic Neurotransmission in the Rat Thalamus[J].2015,52(2).
[31]Fredriksson,A,Ponten,E,Gordh,T,etc.Neonatal exposure to a combination of N-methyl-D-aspartate and gamma-aminobutyric acid type A receptor anesthetic agents potentiates apoptotic neurodegeneration and persistent behavioral deficits.[J].2007,107(3).
[32]Aksenov, Daniil P.,Miller, Michael J.,Li, Limin,etc.Eyeblink classical conditioning and BOLD fMRI of anesthesia-induced changes in the developing brain[J].2016,167.
[33]William, Slikker,Xiaoju, Zou,Charlotte E, Hotchkiss,etc.Ketamine-induced neuronal cell death in the perinatal rhesus monkey.[J].2007,98.
[34]Catherine E Creeley,Krikor T Dikranian,Gregory A Dissen,etc.Isoflurane-induced apoptosis of neurons and oligodendrocytes in the fetal rhesus macaque brain.[J].2014,120(3).
[35]Creeley.Propofol-induced apoptosis of neurones and oligodendrocytes in fetal and neonatal rhesus macaque brain.[J].2013,110.
[36]Fredriksson A,Archer T,Alm H,etc.Neurofunctional deficits and potentiated apoptosis by neonatal NMDA antagonist administration.[J].2004,153(2).
[37]James D, O'Leary,Magdalena, Janus,Eric, Duku,etc.A Population-based Study Evaluating the Association between Surgery in Early Life and Child Development at Primary School Entry.[J].2016.
[38]Schenning, Katie J.,Noguchi, Kevin K.,Martin, Lauren Drew,etc.Isoflurane exposure leads to apoptosis of neurons and oligodendrocytes in 20-and 40-day old rhesus macaques[J].2017,60.
[39]Xianshu,Ju,Yunseon,Jang,Jun Young,Heo,etc.Anesthesia affects excitatory/inhibitory synapses during the critical synaptogenic period in the hippocampus of young mice: Importance of sex as a biological variable.[J].2018,70.
[40]Liu, Fang,Patterson, Tucker A.,Paule, Merle G.,etc.Potential Adverse Effects of Prolonged Sevoflurane Exposure on Developing Monkey Brain: From Abnormal Lipid Metabolism to Neuronal Damage[J].2015,147(2).
[41]Jun-Heum Yon,Lisa B. Carter,Russel J. Reiter,etc.Melatonin reduces the severity of anesthesia-induced apoptotic neurodegeneration in the developing rat brain[J].2006,21(3).
[42]Ori C,Carter LB,Jevtovic-Todorovic V,etc.Clinical anesthesia causes permanent damage to the fetal guinea pig brain.[J].2008,18(2).
[43]Jevtovic-Todorovic, Vesna,Todorovic, Slobodan M.,Beenhakker, Mark P.,etc.Histone Deacetylase Inhibitor Entinostat (MS-275) Restores Anesthesia-induced Alteration of Inhibitory Synaptic Transmission in the Developing Rat Hippocampus[J].2018,55(1).
[44]Coleman, Kristine,Robertson, Nicola D.,Dissen, Gregory A.,etc.Isoflurane Anesthesia Has Long-term Consequences on Motor and Behavioral Development in Infant Rhesus Macaques[J].2017,126(1).
[45]Lu,H.-S.,Kong,F.-J.,Ma,L.-L.,etc.Fetal exposure to high isoflurane concentration induces postnatal memory and learning deficits in rats[J].2012,84(4).
[46]Raper, Jessica,Alvarado, Maria C.,Murphy, Kathy L.,etc.Multiple Anesthetic Exposure in Infant Monkeys Alters Emotional Reactivity to an Acute Stressor[J].2015,123(5).
[47]Allen RR,Wang C,Hotchkiss C,etc.Ketamine anesthesia during the first week of life can cause long-lasting cognitive deficits in rhesus monkeys.[J].2011,33(2).
[48]Evers AS,Avidan MS,Dissen GA,etc.Isoflurane-induced neuroapoptosis in the neonatal rhesus macaque brain.[J].2010,112(4).
[49]Chung, Woosuk,Park, Saegeun,Hong, Jiso,etc.Sevoflurane exposure during the neonatal period induces long-term memory impairment but not autism-like behaviors[J].2015,25(10).
[50]Graham, M. Ruth,Brownell, Marni,Chateau, Daniel G.,etc.Neurodevelopmental Assessment in Kindergarten in Children Exposed to General Anesthesia before the Age of 4 Years A Retrospective Matched Cohort Study[J].2016,125(4).
[51]Jevtovic-Todorovic V,Hartman RE,Izumi Y,etc.Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits.[J].2003,23(3).
[52]Hanson CJ,Bootman MD,Roderick HL.Cell Signalling: IP(3) Receptors Channel Calcium into Cell Death[J].2004,14(21).
[53]J Donald Joseph,Yi Peng,Don-On Daniel Mak,etc.General anesthetic isoflurane modulates inositol 1,4,5-trisphosphate receptor calcium channel opening.[J].2014,121(3).
[54]Sanchez V,Feinstein SD,Lunardi N,etc.General Anesthesia Causes Long-term Impairment of Mitochondrial Morphogenesis and Synaptic Transmission in Developing Rat Brain.[J].2011,115(5).
[55]DiGruccio, Michael R.,Joksimovic, Srdjan,Joksovic, Pavle M.,etc.Hyperexcitability of Rat Thalamocortical Networks after Exposure to General Anesthesia during Brain Development[J].2015,35(4).
[56]Augustine M.K. Choi,Stefan W. Ryter,Beth Levine.Autophagy In Human Health and .Disease[J].2013,368(7).
[57]Daniel Johnson J,Yon JH,Carter LB,etc.Anesthesia induces neuronal cell death in the developing rat brain via the intrinsic and extrinsic apoptotic pathways.[J].2005,135(3).
[58]Decuypere JP,Monaco G,Bultynck G,etc.The IP(3) receptor-mitochondria connection in apoptosis and autophagy.[J].2011,1813(5).
[59]Liang, Chao,Du, Fang,Cang, Jing,etc.Pink1 attenuates propofol-induced apoptosis and oxidative stress in developing neurons[J].2018,32(1).
[60]Milanovic, Desanka,Pesic, Vesna,Loncarevic-Vasiljkovic, Natasa,etc.Neonatal Propofol Anesthesia Changes Expression of Synaptic Plasticity Proteins and Increases Stereotypic and Anxyolitic Behavior in Adult Rats[J].2017,32(2).
[61]Head BP,Patel HH,Niesman IR,etc.Inhibition of p75 neurotrophin receptor attenuates isoflurane-mediated neuronal apoptosis in the neonatal central nervous system.[J].2009,110(4).
[62]Petersen, Steven E.,Sporns, Olaf.Brain Networks and Cognitive Architectures[J].2015,88(1).
[63]Wei H,Inan S.The cytoprotective effects of dantrolene: a ryanodine receptor antagonist.[J].2010,111(6).
[64]J, Dobbing,J, Sands.Comparative aspects of the brain growth spurt.[J].1979,3(1).