Neuroprotective and Neurotoxic Properties of General Anesthetics: A Double-Edged Sword

Huafeng Wei , Alexander T. King , Saadet Inan
Department of Anaesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
J Anesth Perioper Med 2015; 2(3): 158- 166 . Published on May 1, 2015 . doi:10.24015/JAPM.2015.0022
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Aim of review: Summarize current and past studies on the neuroprotective and neurotoxic properties of general anesthetics.

Method: We have reviewed general anesthetic-induced dual effects of neuroprotection and neurotoxicity in cell culture, animal, and human studies.

Recent findings: We have analyzed the contributing factors to the dual effects of neuroprotection and neurotoxicity by general anesthetics. Particularly, the concentration of intracellular calcium may moderate such dual effects of general anesthetics. A modest increase of intracellular calcium by general anesthetics provides neuroprotection, while an excessive or abnormal increase of intracellular calcium may result in neurotoxicity. Future studies are needed to identify the demarcation point upon which the use of general anesthetics becomes neurotoxic. By highlighting this issue, the article fills a gap in the general anesthetic literature. 

Summary: The variables governing the neuroprotective and neurotoxic effects of general anesthetics appear to be patient age, concentration of general anesthetic used, and length of anesthetic exposure. Preclinical studies suggested that preconditioning with inhalational anesthetics, especially isoflurane at low concentrations, provides neuroprotection. However, inhalational anesthetics can also cause neurotoxicity when used at high concentrations for prolonged periods. Elderly subjects with preexisting neurodegenerative conditions and subjects in their prenatal or postnatal periods seem sensitive to the neurotoxic effects of general anesthesia.



Citation: Hua-Feng Wei, Alexander T. King, Saadet Inan. Neuroprotective and neurotoxic properties of general anesthetics: a double-edged sword. J Anesth Perioper Med 2015; 2: 158-66. doi: 10.24015/JAPM.2015.0022

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