Journal
BRITISH JOURNAL OF ANAESTHESIA
Volume 111, Issue 2, Pages 143-151Publisher
OXFORD UNIV PRESS
DOI: 10.1093/bja/aet177
Keywords
anaesthesia; general; anaesthetics; cognitive disorder; neurotoxicity syndromes; postoperative complications
Categories
Funding
- National Institute of Academic Anaesthesia
- Dutch Association of Anesthesiologists
- Swedish Research Council
- Swedish Childhood Cancer Foundation
- Swedish Cancer Foundation
- StratNeuro Network at the Karolinska Institute
- Stockholm and Gothenburg Freemasons' Pediatric Research
- National Institutes of Health (Bethesda, MD, USA) [K08 GM077057, R01 GM088817, 2P01 1HD16596-26, GM49831, NS053898, GM58055, NS56315]
- US Air Force [FA8650-11-2-6D04]
- US Army [W81XWH-13-1-0016, W81XWH-09-2-0187]
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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.
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