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Anesthetics and brain protection

Head, Brian Pa; Patel, Piyusha,b

Current Opinion in Anesthesiology: October 2007 - Volume 20 - Issue 5 - p 395–399
doi: 10.1097/ACO.0b013e3282efa69d
Neuroanaesthesia

Purpose of review There is a considerable risk of cerebral ischemia during anesthesia and surgery. Anesthetic agents have been shown to have a profound effect on the pathophysiology of cerebral ischemia. The present review provides a brief historical review and details new information about the anesthetic effects on the ischemic brain.

Recent findings Although anesthetics have been shown to reduce ischemic cerebral injury, the durability of this neuroprotection has been questioned. Recent data indicate that, under the right circumstances, anesthetic neuroprotection can be sustained for at least 2–4 weeks; the durability of this protection is dependent upon the experimental model, control of physiologic parameters and the assurance of the adequacy of reperfusion. In addition, volatile anesthetics have been shown to accelerate postischemic neurogenesis; this suggests that anesthetics may enhance the endogenous reparative processes in the injured brain.

Summary The available data indicate that anesthetics can provide long-term durable protection against ischemic injury that is mild to moderate in severity. Experimental data do not provide support for the premise that anesthetics reduce injury when the ischemic injury is severe.

aDepartment of Anesthesiology, University of California, San Diego, USA

bVA Medical Center, San Diego, USA

Correspondence to Piyush Patel, MD, Anesthesia 125, VA Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161, USA Tel: +1 858 642 3150; fax: +1 858 534 0104; e-mail: ppatel@ucsd.edu

© 2007 Lippincott Williams & Wilkins, Inc.