martes, 25 de octubre de 2016

Neurotoxicidad por anestesia / Anesthesia neurotoxicity

Octubre 11, 2016. No. 2475

De la neuroapoptosis inducida por fármacos a la neurotoxicidad pediátrica por anestesia. ¿Dónde estamos ahora?
From Drug-Induced Developmental Neuroapoptosis to Pediatric Anesthetic Neurotoxicity-Where Are We Now?
Brain Sci. 2016 Aug 16;6(3). pii: E32. doi: 10.3390/brainsci6030032.
The fetal and neonatal periods are critical and sensitive periods for neurodevelopment, and involve rapid brain growth in addition to natural programmed cell death (i.e., apoptosis) and synaptic pruning. Apoptosis is an important process for neurodevelopment, preventing redundant, faulty, or unused neurons from cluttering the developing brain. However, animal studies have shown massive neuronal cell death by apoptosis can also be caused by exposure to several classes of drugs, namely gamma-aminobutyric acid (GABA) agonists and N-methyl-d-aspartate (NMDA) antagonists that are commonly used in pediatric anesthesia. This form of neurotoxic insult could cause a major disruption in brain development with the potential to permanently shape behavior and cognitive ability. Evidence does suggest that psychoactive drugs alter neurodevelopment and synaptic plasticity in the animal brain, which, in the human brain, may translate to permanent neurodevelopmental changes associated with long-term intellectual disability. This paper reviews the seminal animal research on drug-induced developmental apoptosis and the subsequent clinical studies that have been conducted thus far. In humans, there is growing evidence that suggests anesthetics have the potential to harm the developing brain, but the long-term outcome is not definitive and causality has not been determined. The consensus is that there is more work to be done using both animal models and human clinical studies.
KEYWORDS: cognitive development; drugs; early brain development; neurodevelopment
Neurotoxicidad inducida por propofol en el cerebro fetal de animales y avances en la modificación de estos efectos
Propofol-Induced Neurotoxicity in the Fetal Animal Brain and Developments in Modifying These Effects-An Updated Review of Propofol Fetal Exposure in Laboratory Animal Studies.
Brain Sci. 2016 Mar 28;6(2). pii: E11. doi: 10.3390/brainsci6020011Abstract
In the past twenty years, evidence of neurotoxicity in the developing brain in animal studies from exposure to several general anesthetics has been accumulating. Propofol, a commonly used general anesthetic medication, administered during synaptogenesis, may trigger widespread apoptotic neurodegeneration in the developing brain and long-term neurobehavioral disturbances in both rodents and non-human primates. Despite the growing evidence of the potential neurotoxicity of different anesthetic agents in animal studies, there is no concrete evidence that humans may be similarly affected. However, given the growing evidence of the neurotoxic effects of anesthetics in laboratory studies, it is prudent to further investigate the mechanisms causing these effects and potential ways to mitigate them. Here, we review multiple studies that investigate the effects of in utero propofol exposure and the developmental agents that may modify these deleterious effects.
KEYWORDS: apoptosis; in utero; neurotoxicity; propofol
Consideraciones del uso de anestésicos en estudios de neurotoxicidad
Considerations for the use of anesthetics in neurotoxicity studies.
Comp Med. 2010 Aug;60(4):256-62.
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.

XIII Congreso Virtual Mexicano de Anestesiología
Octubre a Diciembre 2016

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L Congreso Mexicano de Anestesiología
Noviembre 2-6, 2016
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