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Anesthesia and the developing brain: are we getting closer to understanding the truth?

Jevtovic-Todorovic, Vesna

Current Opinion in Anaesthesiology: August 2011 - Volume 24 - Issue 4 - p 395–399
doi: 10.1097/ACO.0b013e3283487247
Drugs in anesthesia: Edited by Thomas K. Henthorn
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Purpose of review Due to increased frequency of surgical interventions, infants and young children are exposed to anesthesia, often repeatedly, during an extremely delicate period of brain development. We review new evidence that continues to challenge the safety of this practice.

Recent findings In animal models, anesthesia impairs normal synapse development and sculpting, which are crucial elements of developmental synaptogenesis. This age-dependent phenomenon is caused in part by actin cytoskeleton disorganization and impaired dendritic branching. Recent evidence also suggests that developing glia are sensitive to anesthesia-induced toxicity, which is manifested as stunted growth, delayed maturation, and disturbed process formation. Newly published findings in nonhuman primates, which report long-lasting cognitive impairment, stress the potential seriousness of anesthesia-induced developmental neurotoxicity.

Summary Although clinical importance remains to be substantiated, results to date do indicate that exposure of animals to general anesthesia during active synaptogenesis is most detrimental. Accordingly, it is essential to determine when synaptogenesis begins and ends in developing humans. It is also imperative that effective preventive techniques be developed so that existing anesthetics can be used with minimum risk of neurotoxic side-effects of anesthesia.

Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA

Correspondence to Vesna Jevtovic-Todorovic, Department of Anesthesiology, University of Virginia Health System, P.O. Box 800710, Charlottesville, VA 22908, USATel: +1 434 924 2283; fax: +1 434 982 0019; e-mail: vj3w@virginia.edu

© 2011 Lippincott Williams & Wilkins, Inc.