FAER  |   February 2019
FAER: Broadly Funding Research on Anesthesia and the Brain
Article Information
Central and Peripheral Nervous Systems / Education / CPD / FAER
FAER   |   February 2019
FAER: Broadly Funding Research on Anesthesia and the Brain
ASA Monitor 2 2019, Vol.83, 66-67.
ASA Monitor 2 2019, Vol.83, 66-67.
The ASA’s Perioperative Brain Health Initiative is an important undertaking aimed at minimizing perioperative cognitive and psychiatric dysfunction. Most attention is focused on maintaining cognition and avoiding delirium postoperatively in elderly surgical patients, who are most at risk for clinically-obvious deterioration in brain function. A broader vision of physician anesthesiologists’ role in brain health would be optimizing brain function for all those receiving anesthetic and analgesic drugs, during all episodes of care involving an anesthesiologist, intensivist or pain medicine physician.
The human brain is, arguably, the most complex system in the known universe, with an estimated 120 billion neurons1  that make approximately 1,000 times more synaptic connections with one another.2  Most anesthetics and analgesics have known receptor pharmacology that interacts with this vast neural network, but the full impact of these medications on complex cognitive functions is incompletely described. In addition to the obvious clinical effects we observe daily, there is almost always more than meets the eye. Take, as an example, induction of general anesthesia. We reliably observe loss of behavioral response to stimuli, but a large body of EEG and fMRI literature reveal that local brain activity in primary sensory cortices is preserved, as well as coherent neuronal communication between brain structures within coordinated networks.3  What probably represents the true “mechanism” of loss of consciousness is not diffuse suppression of neuronal activity, but rather disrupted communication between functionally distinct brain systems3  and decreased long-range connectivity.4 
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