Anesthetic Neurotoxicity

By June 3, 2019Uncategorized

Delivery of anesthetic drugs undoubtedly work on areas of the brain, spinal cord, and peripheral nerves to achieve their desired effects. The risks of exposure to anesthetic agents during development has become a burgeoning study in basic and clinical science. In laboratory settings, exposure to inhaled anesthetics has resulted in cellular changes in animal and in vitro models [1]. Because of many confounding factors regarding early neural development, types of anesthetic agents used, underlying morbidity, and uncertain neurocognitive trajectories in young children requiring anesthesia and surgery, the risk of anesthesia in the pediatric population on development, behavior, and later cognition, are not certain.

Clarification of the risk of specific agents on the developing brain are underway at multiple centers around the United States [2]. Given the nature of this clinical question, the results are years away and are likely to generate more inquiries. Several observational studies, such as the MASK study from Mayo Clinic, will attempt to elucidate whether developmental differences exist between children who have been exposed to anesthesia and surgery prior to age three and those who have had no early exposure. Other studies, such as the GAS study and T-Rex study, will test whether a specific anesthetic regimen (e.g., general vs. spinal anesthetic or dexmedetomidine with remifentanil) will later correlate with neuropsychiatric problems in children as they are followed after their anesthetic encounters. Appropriate use of anesthetic drugs in any age can facilitate surgery. Clinically meaningful downstream effects of have yet to be elucidated.

Among patients of advanced age, several efforts have investigated whether anesthetic exposure modifies amyloid plaque deposition, which is a hallmark