Anaesthetic neurotoxicity and neuroplasticity: an expert group report and statement based on the BJA Salzburg Seminar
Vesna Jevtovic-Todorovic,Anthony Absalom,Klas Blomgren,Ansgar M. Brambrink,G. Crosby,Deborah J. Culley,Gary Fiskum,Rona G. Giffard,Karl F. Herold,Andreas W. Loepke,Daqing Ma,Beverley A. Orser,Emmanuel Planel,W. Slikker,Sulpicio G. Soriano,G. Stratmann,Laszlo Vutskits,Zhongcong Xie,Hugh C. Hemmings +18 more
TLDR
mounting evidence from preclinical studies reveals general anaesthetics to be powerful modulators of neuronal development and function, which could contribute to detrimental behavioural outcomes, however, definitive clinical data remain elusive.Abstract:
Although previously considered entirely reversible, general anaesthesia is now being viewed as a potentially significant risk to cognitive performance at both extremes of age. A large body of preclinical as well as some retrospective clinical evidence suggest that exposure to general anaesthesia could be detrimental to cognitive development in young subjects, and might also contribute to accelerated cognitive decline in the elderly. A group of experts in anaesthetic neuropharmacology and neurotoxicity convened in Salzburg, Austria for the BJA Salzburg Seminar on Anaesthetic Neurotoxicity and Neuroplasticity. This focused workshop was sponsored by the British Journal of Anaesthesia to review and critically assess currently available evidence from animal and human studies, and to consider the direction of future research. It was concluded that mounting evidence from preclinical studies reveals general anaesthetics to be powerful modulators of neuronal development and function, which could contribute to detrimental behavioural outcomes. However, definitive clinical data remain elusive. Since general anaesthesia often cannot be avoided regardless of patient age, it is important to understand the complex mechanisms and effects involved in anaesthesia-induced neurotoxicity, and to develop strategies for avoiding or limiting potential brain injury through evidence-based approaches.read more
Citations
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Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial
Andrew Davidson,Nicola Disma,Jurgen C. de Graaff,Davinia E. Withington,Liam Dorris,Graham Bell,Robyn Stargatt,Robyn Stargatt,David C. Bellinger,David C. Bellinger,Tibor Schuster,Sarah J Arnup,Pollyanna Hardy,Rodney W. Hunt,Rodney W. Hunt,Michael Takagi,Gaia Giribaldi,Penelope L Hartmann,Ida Salvo,Neil S. Morton,Britta S von Ungern Sternberg,Britta S von Ungern Sternberg,Bruno Guido Locatelli,Niall C. T. Wilton,Anne M. Lynn,Joss J. Thomas,David M. Polaner,Oliver Bagshaw,Peter Szmuk,Anthony Absalom,Geoff Frawley,Charles B. Berde,Gillian D Ormond,Jacki Marmor,Mary Ellen McCann +34 more
TL;DR: This trial found no evidence that just under an hour of sevoflurane anaesthesia in infancy increases the risk of adverse neurodevelopmental outcome at two years of age compared to RA.
Journal ArticleDOI
Clinical Pharmacokinetics and Pharmacodynamics of Propofol.
TL;DR: An overview of the PK and PD of propofol is provided in order to refresh readers’ knowledge of its clinical applications, while discussing the main avenues of research where significant recent advances have been made.
Journal ArticleDOI
Anesthetic Neurotoxicity — Clinical Implications of Animal Models
TL;DR: The FDA collaboration SmartTots recommends undertaking large-scale clinical studies and avoiding nonurgent surgical procedures requiring anesthesia in children younger than 3 years of age.
Journal ArticleDOI
Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort.
Danqing Hu,Randall P. Flick,Michael J. Zaccariello,Robert C. Colligan,Slavica K. Katusic,Darrell R. Schroeder,Andrew C. Hanson,Shonie L. Buenvenida,Stephen J. Gleich,Robert T. Wilder,Juraj Sprung,David O. Warner +11 more
TL;DR: Findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention.
Journal ArticleDOI
Executive Function in Children and Adolescents with Critical Cyanotic Congenital Heart Disease
TL;DR: With increased understanding of the cognitive and self-regulatory vulnerabilities experienced by children and adolescents with CHD, it may be possible to identify risks early and provide individualized supports to promote optimal neurodevelopment.
References
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Depth of anaesthesia and post-operative cognitive dysfunction.
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Journal ArticleDOI
Sevoflurane anesthesia does not impair acquisition learning or memory in the Morris water maze in young adult and aged rats.
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Inhibition of α5 γ-Aminobutyric acid type A receptors restores recognition memory after general anesthesia.
TL;DR: This proof-of-concept study shows that &agr;5GABAA receptors are necessary for the development of postanesthetic deficits in recognition memory and that these receptors can be targeted to restore memory even after the anesthetic has been eliminated.
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Nitrous oxide (N(2)O) requires the N-methyl-D-aspartate receptor for its action in Caenorhabditis elegans.
TL;DR: The behavioral effects of N(2)O require the NMDA receptor NMR-1, consistent with the hypothesis formed from vertebrate electrophysiological data that a major target of N2O is theNMDA receptor.
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Alzheimer's disease and anesthesia.
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Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial
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