An update on anesthetics and impact on the brain

ABSTRACT

Introduction: While anesthetics are indispensable clinical tools and generally considered safe and effective, a growing concern over the potential neurotoxicity of anesthesia or specific anesthetic agents has called into question the safety of general anesthetics, especially when administered at extremes of age.

Areas covered: This article reviews and updates research findings on the safety of anesthesia and anesthetics in terms of long-term neurotoxicity, with particular focus on postoperative cognitive dysfunctions, Alzheimer’s disease and dementias, developing brain, post-operative depression and autism spectrum disorder.

Expert opinion: Exposure to general anesthetics is potentially harmful to the human brain, and the consequent long-term cognitive deficits should be classified as an iatrogenic pathology, and considered a public health problem. The fact that in laboratory and clinical research only certain anesthetic agents and techniques, but not others, appear to be involved, raises the problem on what is the safest and the least safe anesthetic to maximize anesthesia efficiency, avoid occurrence of adverse events, and ensure patient safety. New trends in research are moving toward the theory that neuroinflammation could be the hallmark of, or could have a pivotal role in, several neurological disorders.

KEYWORDS:

• Alzheimer’s disease
• anesthesia
• autism spectrum disorder
• developing brain
• neuroinflammation
• neurotoxicity
• postoperative cognitive dysfunctions
• safety

Article highlights

• Anesthetics are indispensable clinical tools and generally considered safe, but there is growing concern about long-term potential neurotoxicity.

• Postoperative cognitive dysfunctions, a decline in cognitive functions and temporary memory problems occurring after surgery and anesthesia, can persist for days to months and, in some cases, longer.

• There is a possible link between general anesthetics and induced changes in molecules known to be involved in the pathogenesis of Alzheimer’s Disease.

• Exposure of children up to 3 years of age to general anesthetics may affect CNS development, resulting in long-lasting cognitive and behavioral deficiencies, such as learning and memory deficits.

• In recent years, scientists have also addressed the potential role of general anesthesia in the development of post-operative depression and autism spectrum disorder.

• Neuroinflammation activation, due to surgery and anesthesia, could be a key factor in the pathogenesis of neurotoxicity.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.