Neurotoxicity of Inhaled Anesthetics in Infant

Abstract

The administration of general anesthetics may potentially cause adverse effects such as long-term neurocognitive impairment induced by neuroapoptosis. Although many investigations have been made, the mechanism of these effects on the central nervous system（CNS）remains unclear. Previous studies have denied such adverse effects of general anesthetics on the immature CNS. In the 2000s, however, ketamine, nitrous oxide, midazolam, isoflurane and propofol were found to induce widespread neuroapoptosis in infant animal models. Since then, many arguments regarding the neurotoxicity of general anesthetics have been made. The stimulation of GABA or NMDA receptors may lead to neuroapoptosis in infant animal models. Furthermore, a recent study suggests that general anesthetics can suppress synaptogenesis in an infant rodent model. In humans, accumulating retrospective data suggest that general anesthetics may produce long-term cognitive impairments, whereas prospective studies such as the PANDA and GAS trials have emphasized the safety of general anesthetics for the developing brain in healthy children. However, these prospective studies leave an important question unanswered：the impact of repeated and prolonged exposure to anesthesia in children. Further studies examining the noxious effect of general anesthetics on the developing brain in humans are essential.