Anestesia, cerebro y neurotoxicidad

Efectos de la anestesia general sobre el cerebro en desarrollo


Effect of general anesthetics on the developing brain.
Reddy SV.
Department of Anaesthesiology, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India.
J Anaesthesiol Clin Pharmacol. 2012 Jan;28(1):6-10.
Abstract
Studies on rodents and subhuman primates suggest that prolonged exposure to general anesthetics may induce widespread neuronal cell death and neurological sequelae; seriously questioning the safety of pediatric anesthesia. This review presents recent developments in this rapidly emerging field. There is mounting and convincing preclinical evidence in rodents and nonhuman primates that anesthetics in common clinical use are neurotoxic to the developing brain in vitro and cause long-term neurobehavioral abnormalities in vivo. Prior to the publication of animal data and after the publication of animal data, there are several human cohort studies that demonstrate the association of poor neurodevelopmental outcome in neonates, who underwent major surgery during their neonatal period. This review summarizes our present understanding of some of the key components responsible for anesthesia-induced neuroapoptosis and offers some of neuroprotective strategies that could be beneficial as adjunct therapy in preventing anesthesia-induced death of developing neurons in the neonates. A randomized literature search was carried out using search words apoptosis, general anesthetics, and developing brain from 1979 to 2011 for effects of general anesthetics on developing brain in PUBMED and relevant published literature reviewed. General anesthetics may produce neurotoxicity and enduring cognitive impairment in young and aged animals, but the issue has not been adequately studied in humans. It is premature to recommend a change clinical practice based on the present data.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275974/




Consideraciones para el uso de anestésicos en estudios de neurotoxicidad


Considerations for the use of anesthetics in neurotoxicity studies.
Karmarkar SW, Bottum KM, Tischkau SA.
Department of Pharmacology, School of Medicine, Southern Illinois University, Springfield, IL, USA.
Comp Med. 2010 Aug;60(4):256-62

Abstract
Anesthetics are widely used in experiments investigating neurotoxicity and neuroprotection; however, these agents are known to interfere with the outcome of these experiments. The purpose of this overview is to review these effects and suggest methods for minimizing unintended consequences on experimental outcomes. Information on the neuroprotective and neurotoxic effects of isoflurane, dexmedetomidine, propofol, ketamine, barbiturates, halothane, xenon, carbon dioxide, and nitrous oxide is summarized. The pertinent cell signaling pathways of these agents are discussed. Methods of humane animal euthanasia without anesthetics are considered. Most anesthetics alter the processes of neuronal survival and death. When designing survival surgeries, sham controls subjected to anesthesia but not the surgical intervention should be compared with controls subjected to neither anesthesia nor surgery. Additional controls could include using an anesthetic with a different mechanism of action from the primary anesthetic used. Because the effects of anesthetics lessen with time after surgery, survival surgeries should include later time points until at least 7 d after the procedure. Humane methods of animal euthanasia that do not require anesthetics exist and should be used whenever appropriate.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930323/pdf/cm2010000256.pdf


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930323/







Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org