SubSpecialties  |   July 2013
New Developments in Neuroanesthesiology
Article Information
Central and Peripheral Nervous Systems / Neurosurgical Anesthesia / SubSpecialties
SubSpecialties   |   July 2013
New Developments in Neuroanesthesiology
ASA Monitor 07 2013, Vol.77, 58-59.
ASA Monitor 07 2013, Vol.77, 58-59.
The practice of contemporary neuroanesthesiology demands that the anesthesiologist have a fundamental understanding of the primary implications of neurologic diseases as well as the secondary changes that neurologic diseases can have on systemic physiology, or alternatively that systemic diseases can have on neurologic function. Additionally, our fundamental understanding is evolving for many disease processes, factors affecting patients’ risk for injury and options for reducing risk. In this overview, I will briefly review four topics currently on the forefront of research and innovation in neuroanesthesiology: anesthetic-induced neurotoxicity, perioperative blindness, brain monitoring, and neuroanesthesiology subspecialty training.
Is it possible that certain anesthetic drugs that protect neurons from injury in some instances can cause neuronal injury in others? In the past, much research focused on the neuroprotective effects of anesthetic drugs. Although that area of research is still flourishing, new lines of investigation have identified potentially neurotoxic effect of anesthetics. This research suggests that the brains of the very young and very old are possibly the most susceptible to anesthetic neurotoxicity.1  In children, exposure to multiple anesthetics correlates with an increased incidence of long-term developmental, learning and behavioral disorders, although it is not clear if this association results from a direct toxic effect of anesthetics or occurs because “sicker” children require more surgery and more anesthetics (i.e., thus chronic illness is a confounding factor in interpreting the data).2,3  In elderly patients, anesthetic neurotoxicity may manifest as postoperative cognitive dysfunction.4  Although the mechanisms for these associations are not clear, current data suggest that, depending on the age group, anesthetic activation of neuronal apoptotic pathways, alterations in synaptogenesis and synaptic plasticity, neurogenesis and differentiation, and, more recently, anesthetic-induced neuronal accumulation of tau protein and inflammation may all play a role. For readers interested in anesthetic neurotoxicity, I refer you to the March 2013 issue of Anesthesiology that contains a collection of recent articles describing novel findings and accompanying editorials relevant to this topic.
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