Update on developmental anesthesia neurotoxicity

  title={Update on developmental anesthesia neurotoxicity},
  author={Laszlo Vutskits and Andrew J Davidson},
  journal={Current Opinion in Anaesthesiology},
Purpose of review Adverse long-term impact of general anesthesia on the developing brain is a widely discussed and controversial issue with potential public health relevance. The goal of this article is to give insights into the most recent experimental and clinical observations aimed to advance our understanding in this field. Recent findings Recent investigations demonstrate long-term behavioral consequences of early-life anesthesia exposure in nonhuman primates under experimental conditions… 

Neurotoxicity of anesthetics: Mechanisms and meaning from mouse intervention studies.

Relevance of experimental paradigms of anesthesia induced neurotoxicity in the mouse

It is found that 2 or more hours of anesthesia exposure results in dramatic respiratory and metabolic changes that may limit interpretation of this paradigm to the clinical situation, and indicates that neonatal mouse models of AIN are not necessarily appropriate representations of human exposures.

Clinical update regarding general anesthesia-associated neurotoxicity in infants and children.

It is suggested that anesthetic neurotoxicity is not a major contributory pathway for adverse neurodevelopmental outcomes in the majority of healthy children who require surgery before 3 years of age.

Neurotoxic Impact of Individual Anesthetic Agents on the Developing Brain

Multiple landmark studies have provided reassurance that brief exposure to anesthesia is not associated with adverse neurocognitive outcomes in infants and children, regardless of the type of anesthetic agent used.

Ketamine-induced neurotoxicity in neurodevelopment: A synopsis of main pathways based on recent in vivo experimental findings

A brief review of the cellular and molecular mechanisms suggested to mediate ketamine-induced developmental neurotoxicity, utilizing a selected number of recent in vivo experimental evidence is attempted.

Mechanisms of Anesthetic Action and Neurotoxicity: Lessons from Molluscs

The findings presented here underscore the importance of invertebrates for research in the field of anesthesiology while highlighting their relevance to both vertebrates and humans.

Can We Really Suggest that Anesthesia Might Cause Attention-deficit/Hyperactivity Disorder?

An association between childhood exposure to multiple anesthetics and increased risk of learning disability and attention-deficit/hyperactivity disorder (ADHD) and the associations were stronger with multiple exposures compared with single exposures.

Dexmedetomidine-mediated neuroprotection against sevoflurane-induced neurotoxicity extends to several brain regions in neonatal rats

The findings suggest that DEX could be an attractive therapeutic for future studies investigating its neuroprotective potential in a translational animal model and SEVO anaesthesia induced widespread apoptosis in infant rat brain.

Implication of microglia in ketamine-induced long-term cognitive impairment in murine pups

It is found that multiple exposures to ketamine in neonatal mice lead to spatiallearning and memory dysfunction and the alterations of microglial development and function are the possible mechanisms of long-term learning and memory impairment.

Maternal sciatic nerve administered bupivacaine induces hippocampal cell apoptosis in offspring

The data suggest that maternal bupivacaine use increases fetal hippocampal cell apoptosis markers such as caspase 8 and cleaved caspases 3, at least in part, via inhibiting the Akt activation.



Clinical Research Into Anesthetic Neurotoxicity: Does Anesthesia Cause Neurological Abnormalities in Humans?

The current state of clinical research into the effects of anesthetic exposure in human brain development is summarized, some of the difficulties in examining the phenomenon are addressed, and the most recent clinical findings presented at the PANDA symposium are introduced.

Isoflurane Anesthesia Has Long-term Consequences on Motor and Behavioral Development in Infant Rhesus Macaques

Neonatal exposure to isoflurane, particularly when repeated, has long-term behavioral consequences affecting both motor and socioemotional aspects of behavior.

Lasting impact of general anaesthesia on the brain: mechanisms and relevance

Available mechanistic data linking general-anaesthesia exposure to impaired cognitive performance in both young and mature nervous systems are reviewed, providing a critical appraisal of the translational value of animal models.

Current Clinical Evidence on the Effect of General Anesthesia on Neurodevelopment in Children: An Updated Systematic Review with Meta-Regression

The current clinical evidence suggests modestly elevated risk of adverse neurodevelopmental outcomes in children who were exposed to anesthesia/surgery during early childhood, especially for those with multiple times of exposure.

Comparative Analysis of Outcome Measures Used in Examining Neurodevelopmental Effects of Early Childhood Anesthesia Exposure

Exposure to anesthesia in children younger than 3 yr of age and three types of outcomes at age of 10 yr: neuropsychological testing, International Classification of Diseases, 9th Revision, Clinical Modification–coded clinical disorders, and academic achievement showed an increased risk of deficit in exposed children compared with that in unexposed children, whereas academic achievement scores did not.

Association of Anesthesia and Surgery During Childhood With Long-term Academic Performance

Exposure to anesthesia and surgery before age 4 years has a small association with later academic performance or cognitive performance in adolescence on a population level, and the low overall difference in academic performance after childhood exposure to surgery is reassuring.

Multiple Anesthetic Exposure in Infant Monkeys Alters Emotional Reactivity to an Acute Stressor

Increased emotional behavior in monkeys after anesthesia exposure in infancy may reflect long-term adverse effects of anesthesia, and is addressed in a highly translationally relevant rhesus monkey model.

Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood.

Among healthy children with a single anesthesia exposure before age 36 months, compared with healthy siblings with no anesthesia exposure, there were no statistically significant differences in IQ scores in later childhood.

Cognition and Brain Structure Following Early Childhood Surgery With Anesthesia

The present findings suggest that general anesthesia for a surgical procedure in early childhood may be associated with long-term diminution of language abilities and cognition, as well as regional volumetric alterations in brain structure.