Anesthetics and Cognitive Impairments in Developing Children

Jevtović-Todorović, Vesna

doi:10.1001/jamapediatrics.2017.3033

Cited by 9 publications

(5 citation statements)

References 9 publications

(30 reference statements)

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“… 28 New studies are still necessary to demonstrate a cause-and-effect relationship between the use of general anesthesia in children and long-term cognitive dysfunction. Due to this great dilemma and growing evidence demonstrating the inherent risks of anesthesia, 7 none of the present patients underwent sedation scans, and yet it was possible to maintain great image quality with a low rate of motion artifacts.…”

Section: Discussionmentioning

confidence: 98%

“…Other preclinical studies also demonstrated that some sedation drugs can be associated with neurodevelopment delay. 7 , 8 A retrospective cohort with more than 10,000 siblings compared children without developmental or behavioral disorders who had or had not undergone surgery when they were younger than 3 years. The risk of being subsequently diagnosed with developmental and behavioral disorders in children who had surgery when they were younger than 3 years was 60% greater than that of a similar group of siblings who did not undergo surgery (HR 1.6; 95% CI: 1.4–1.8).…”

Section: Discussionmentioning

confidence: 99%

“…Studies in children younger than 3 years who underwent GA have demonstrated that some sedation drugs can be associated with long-lasting functional neurotoxic effects, such as memory impairment and increased risk for developmental and behavioral disorders. 7 , 8 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

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Ultra-low-dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

Dorneles

Pacini

Zanon

et al. 2020

Jornal de Pediatria

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Ultra-low-dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

Dorneles

Pacini

Zanon

et al. 2020

Jornal de Pediatria

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“…Recent advances in anesthesia have led to increased survival of vulnerable populations at the extremes of age, both in the very young and premature as well as in the very old. Tese individuals present with an increased risk of adverse outcomes, including neurocognitive impairment after anesthesia [13][14][15][16]. Extensive population-based cohort studies suggest that adult patients who underwent anesthesia and surgery had double the risk of dementia and were diagnosed in a shorter amount of time [17].…”

Section: Introductionmentioning

confidence: 99%

Differential Susceptibility to Propofol and Ketamine in Primary Cultures of Young and Senesced Astrocytes

Huang,

Tuzer,

Murtha

et al. 2024

Anesthesiology Research and Practice

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The adverse effects of general anesthesia on the long-term cognition of young children and senior adults have become of concern in recent years. Previously, mechanistic and pathogenic investigations focused on neurons, and little is known about the effect of commonly used intravenous anesthetics such as propofol and ketamine on astrocytes. Recently, astrocyte dysfunction has been implicated in a wide range of age-related brain diseases. In this study, we examined the survival and viability of both young and senescent astrocytes in culture after adding propofol and ketamine to the media at varying strengths. Oxidative stimulus was applied to commercially available fetal cell lines of human astrocytes in vitro to induce morphological changes in cellular senescence. Our results indicate that propofol reduces the survival of young astrocytes as compared to controls, as well as to ketamine. These effects were seen in comparisons of total cell count and at both high and low dose concentrations. High doses of propofol also significantly reduced cell viability compared to those exposed to baseline controls and ketamine. Senescent astrocytes, on the other hand, demonstrated cell count reductions as compared to baseline controls and ketamine when exposed to either DMSO or propofol. The data show differential susceptibility of young astrocytes to propofol than to ketamine. The observed cell count reduction may be related to the adverse effects of propofol on mitochondrial function and free radical production, as described in previous studies. We speculate that ketamine may have a more favorable safety profile in infants and young children.

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“…Neurotoxicity induced by anesthetics can lead to neuronal apoptosis and further to cognitive impairment. For this reason, the FDA has also issued a warning that it is necessary to balance the benefits of appropriate anesthesia in young children and pregnant women against the potential risks, especially for procedures that may last longer than 3 hr or if multiple procedures are required in children below 3 years (Jevtovic‐Todorovic, 2017). Although most of the data came from animal studies, general anesthetics have been shown to have adverse effects on cognitive function in infants and young children in recent years (Andropoulos, 2018).…”

Section: Introductionmentioning

confidence: 99%

Prenatal sevoflurane exposure: Effects of iron metabolic dysfunction on offspring cognition and potential mechanism

Zuo

Chang

Thirupathi

et al. 2020

Intl J of Devlp Neuroscience

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For decades, the neurotoxicity caused by anesthetics in mammalian brain development has gained increasing attention. Exposure to anesthetics leads to neurotoxicity and apoptosis of nerve cells, which in turn induces cognitive dysfunction. Although most of the data came from animal studies, general anesthetics have been shown to have adverse effects on cognitive function in infants and young children in recent years. This concern has led to a number of retrospective studies that observed an association between general anesthesia in pregnant women and neurobehavioral problems in fetuses or offspring. Every year, many pregnant women undergo non‐obstetric anesthesia due to various reasons such as traffic accidents, fetal interventions, acute appendicitis, symptomatic cholelithiasis, and trauma. A matter of concern for these pregnant women is whether anesthesia has a detrimental effect on fetal brain development in the womb and whether the fetus has cognitive impairment after birth. In humans, the association of anesthetic exposure in infants with the long‐term impairment of neurologic functions has been reported in several retrospective clinical studies. Recently, we have found that sevoflurane anesthesia during pregnancy in mice‐induced cognitive impairment in the offspring by causing iron deficiency and inhibiting myelinogenesis. Sevoflurane is a commonly used general anesthetic in the hospitals, which can induce neurotoxicity and cause cognitive impairment in fetuses, infants, children, and adults. However, the exact mechanism of sevoflurane‐induced damage to the central nervous system (CNS) is not fully understood. Based on our recent results, this paper reviewed the effects of sevoflurane on cognitive impairment and pathological changes such as neurogenesis, neuronal apoptosis, and iron metabolism dysfunction in the offspring.

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Anesthetics and Cognitive Impairments in Developing Children

Cited by 9 publications

References 9 publications

Ultra-low-dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

Ultra-low-dose chest computed tomography without anesthesia in the assessment of pediatric pulmonary diseases

Differential Susceptibility to Propofol and Ketamine in Primary Cultures of Young and Senesced Astrocytes

Prenatal sevoflurane exposure: Effects of iron metabolic dysfunction on offspring cognition and potential mechanism

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