Lasting effects of general anesthetics on the brain in the young and elderly: "mixed picture" of neurotoxicity, neuroprotection and cognitive impairment.
Lingzhi WuHailin ZhaoHao WengDaqing MaPublished in: Journal of anesthesia (2019)
General anesthetics are commonly used in major surgery. To achieve the depth of anesthesia for surgery, patients are being subjected to a variety of general anesthetics, alone or in combination. It has been long held an illusory concept that the general anesthesia is entirely reversible and that the central nervous system is returned to its pristine state once the anesthetic agent is eliminated from the active site. However, studies indicate that perturbation of the normal functioning of these targets may result in long-lasting desirable or undesirable effects. This review focuses on the impact of general anesthetic exposure to the brain and summarizes the molecular and cellular mechanisms by which general anesthetics may induce long-lasting undesirable effects when exposed at the developing stage of the brain. The vulnerability of aging brain to general anesthetics, specifically in the context of cognitive disorders and Alzheimer's disease pathogeneses are also discussed. Moreover, we will review emerging evidence regarding the neuroprotective property of xenon and anesthetic adjuvant dexmedetomidine in the immature and mature brains. In conclusion, "mixed picture" effects of general anesthetics should be well acknowledged and should be implemented into daily clinical practice for better patient outcome.
Keyphrases
- cerebral ischemia
- white matter
- cognitive impairment
- minimally invasive
- clinical practice
- coronary artery bypass
- newly diagnosed
- early stage
- physical activity
- brain injury
- climate change
- ejection fraction
- cognitive decline
- cardiac surgery
- surgical site infection
- middle aged
- cerebrospinal fluid
- atrial fibrillation
- patient reported outcomes