General Anesthetics in Pediatric Anesthesia: Influences on the Developing Brain

Introduction: Several experimental and clinical studies suggest that drugs used in pediatric anesthesia may exert undesirable effects on the developing central nervous system. The objective of this review was to assess the results and conclusions of published studies on long lasting neurodevelopment disorders following exposure to anesthetics in children in a phase of brain immaturity. Material and Methods: We performed a literature search in several sources (PubMed, SciELO and Cochrane Library) using the terms ‘Pediatric anesthesia OR Pediatric anesthetic OR Developing brain anesthetic OR Developing brain anesthesia AND behavior disorders’. We selected human studies, referring to long lasting neurodevelopment effects after exposure to anesthetics in the first four years of life. Results: Ten retrospective studies met the inclusion criteria. Of these, seven suggest risk of neurobehavioral disorders after exposure of small children to anesthetics, as opposed to the results obtained by the other three. Discussion: Although mostly using large databases, the studies found are retrospective, vary in test groups, include sometimes avoidable confounders and some present inaccuracies in the choice of the test and control populations that can compromise the reliability of the results. Conclusion: Because of the numerous limitations of the few studies available, the reported results are still deemed insufficient to change current clinical practice. However, although it is undisputable that anesthesia should be provided when needed, regardless of age, the warnings found in literature are worrisome, therefore whenever surgery is unavoidable in small children, alternatives that may help reduce the risks of anesthetic exposure should be sought. Keywords: Anesthesia; Anesthetics; Child; Infant; Brain/growth & development; Developmental Disabilities; Cognition Disorders; Review Literature as Topic.

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Isoflurane Is More Deleterious to Developing Brain Than Desflurane: The Role of the Akt/GSK3βSignaling Pathway

BioMed Research International ◽

10.1155/2016/7919640 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

Guorong Tao ◽

Qingsheng Xue ◽

Yan Luo ◽

Guohui Li ◽

Yimeng Xia ◽

...

Keyword(s):

Signaling Pathway ◽

Learning And Memory ◽

Pediatric Anesthesia ◽

Developmental Neurotoxicity ◽

Developing Brain ◽

Spatial Learning And Memory ◽

Postnatal Exposure ◽

Multiple Exposures

Demand is increasing for safer inhalational anesthetics for use in pediatric anesthesia. In this regard, researchers have debated whether isoflurane is more toxic to the developing brain than desflurane. In the present study, we compared the effects of postnatal exposure to isoflurane with those of desflurane on long-term cognitive performance and investigated the role of the Akt/GSK3βsignaling pathway. Postnatal day 6 (P6) mice were exposed to either isoflurane or desflurane, after which the phosphorylation levels of Akt/GSK3βand learning and memory were assessed at P8 or P31. The phosphorylation levels of Akt/GSK3βand learning and memory were examined after intervention with lithium. We found that isoflurane, but not desflurane, impaired spatial learning and memory at P31. Accompanied by behavioral change, only isoflurane decreased p-Akt (ser473) and p-GSK3β(ser9) expressions, which led to GSK3βoveractivation. Lithium prevented GSK3βoveractivation and alleviated isoflurane-induced cognitive deficits. These results suggest that isoflurane is more likely to induce developmental neurotoxicity than desflurane in context of multiple exposures and that the Akt/GSK3βsignaling pathway partly participates in this process. GSK3βinhibition might be an effective way to protect against developmental neurotoxicity.

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Neonatal Exposure to Sevoflurane in Mice Causes Deficits in Maternal Behavior Later in Adulthood

Anesthesiology ◽

10.1097/aln.0000435846.28299.e7 ◽

2014 ◽

Vol 120 (2) ◽

pp. 403-415 ◽

Cited By ~ 34

Author(s):

Yumiko Takaenoki ◽

Yasushi Satoh ◽

Yoshiyuki Araki ◽

Mitsuyoshi Kodama ◽

Ryuji Yonamine ◽

...

Keyword(s):

Hydrogen Gas ◽

Developing Brain ◽

Neonatal Exposure ◽

General Anesthetics ◽

Learning Abilities ◽

Brain Functioning ◽

Female Mice ◽

Maternal Behaviors ◽

Brain Functions ◽

Anesthetic Exposure

Abstract Background: In animal models, exposure to general anesthetics induces widespread increases in neuronal apoptosis in the developing brain. Subsequently, abnormalities in brain functioning are found in adulthood, long after the anesthetic exposure. These abnormalities include not only reduced learning abilities but also impaired social behaviors, suggesting pervasive deficits in brain functioning. But the underlying features of these deficits are still largely unknown. Methods: Six-day-old C57BL/6 female mice were exposed to 3% sevoflurane for 6 h with or without hydrogen (1.3%) as part of the carrier gas mixture. At 7–9 weeks of age, they were mated with healthy males. The first day after parturition, the maternal behaviors of dams were evaluated. The survival rate of newborn pups was recorded for 6 days after birth. Results: Female mice that received neonatal exposure to sevoflurane could mate normally and deliver healthy pups similar to controls. But these dams often left the pups scattered in the cage and nurtured them very little, so that about half of the pups died within a couple of days. Yet, these dams did not show any deficits in olfactory or exploratory behaviors. Notably, pups born to sevoflurane-treated dams were successfully fostered when nursed by control dams. Mice coadministered of hydrogen gas with sevoflurane did not exhibit the deficits of maternal behaviors. Conclusion: In an animal model, sevoflurane exposure in the developing brain caused serious impairment of maternal behaviors when fostering their pups, suggesting pervasive impairment of brain functions including innate behavior essential to species survival.

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Anestesia neuroaxial en gestantes con patología intracraneal

Revista Electrónica AnestesiaR ◽

10.30445/rear.v10i8.633 ◽

2018 ◽

Vol 10 (8) ◽

pp. 2

Author(s):

Helena Benito Naverac

Keyword(s):

Cesarean Delivery ◽

Standard Technique ◽

In Utero ◽

Neuraxial Anesthesia ◽

Developing Brain ◽

Toxic Effects ◽

General Anesthetics ◽

Fetal Exposure ◽

Relaxing Effect

La anestesia neuroaxial es la técnica de elección para el parto por cesárea, de esta forma se evita la instrumentación de la vía aérea, la exposición fetal a los efectos tóxicos de los anestésicos generales sobre el cerebro en desarrollo y el efecto relajante de los agentes inhalados sobre el útero. ABSTRACT Neuraxial anesthesia is the standard technique for a cesarean delivery; this way airway implementation, fetal exposure to toxic effects of general anesthetics on the developing brain and relaxing effect of inhalant agents in utero are avoided.

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