Journal
BRITISH JOURNAL OF ANAESTHESIA
Volume 110, Issue -, Pages 53-72Publisher
ELSEVIER SCI LTD
DOI: 10.1093/bja/aet054
Keywords
brain; anaesthesia; molecular effects; nerve; damage (postoperative); nerve; neurotransmitters; nerve; regeneration
Categories
Funding
- Wellcome Trust
- Action Medical Research
- Association of Anaesthetists of Great Britain
- National Institute of Health (USA)
- National Institute of Health Research
- Australian National Health
- Victorian Government Operational Infrastructure Support Program
- Wellbeing of Women
- Medical Research Council
- Alzheimer's Society
- SPARKS
- UK Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme
- Association of Anaesthetists of Ireland
- Medical Research Council [MR/J00457X/1] Funding Source: researchfish
- MRC [MR/J00457X/1] Funding Source: UKRI
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Accumulating preclinical and clinical evidence suggests the possibility of neurotoxicity from neonatal exposure to general anaesthetics. Here, we review the weight of the evidence from both human and animal studies and discuss the putative mechanisms of injury and options for protective strategies. Our review identified 55 rodent studies, seven primate studies, and nine clinical studies of interest. While the preclinical data consistently demonstrate robust apoptosis in the nervous system after anaesthetic exposure, only a few studies have performed cognitive follow-up. Nonetheless, the emerging evidence that the primate brain is vulnerable to anaesthetic-induced apoptosis is of concern. The impact of surgery on anaesthetic-induced brain injury has not been adequately addressed yet. The clinical data, comprising largely retrospective cohort database analyses, are inconclusive, in part due to confounding variables inherent in these observational epidemiological approaches. This places even greater emphasis on prospective approaches to this problem, such as the ongoing GAS trial and PANDA study.
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