A Scoping Review of the Mechanisms Underlying Developmental Anesthetic Neurotoxicity

Anesthesia makes painful or uncomfortable diagnostic and interventional health care procedures tolerable, however, it may also disrupt key cellular processes in neurons and glia, harm the developing brain, and thereby impair cognition and behavior in children. Many years of studies using in vitro, animal behavioral, retrospective database studies in humans, and several prospective clinical trials in humans have been invaluable in discerning the potential toxicity of anesthetics. The objective of the scoping review conducted by Matthew Thomas Borzage, PhD, and Bradley S. Peterson, MD, was to synthetize the evidence from preclinical studies for various mechanisms of toxicity across diverse experimental designs and relate their findings to those of recent clinical trials in real-world settings.  Their review found an unequivocal yes, that most anesthetics cause neurotoxicity, at least in rodents. When trying to determine a definitive answer as to how their findings relate to the human situation, unfortunately that question still remains elusive. The strongest evidence for neurotoxic effects in humans is from multiple exposures, most likely in the domains of attention and disruptive behaviors, and possibly executive functioning, memory, motor skills, and language abilities.

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