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Anaesthetic neuroprotection in children

does it exist or is it all just bad?

Marchesini, Vanessaa; Disma, Nicolab

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 363–369
doi: 10.1097/ACO.0000000000000723
PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen
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Purpose of review In the last 20 years, data from studies of laboratory animals, including nonhuman primates, have provided ample evidence that general anaesthetic drugs cause pathological changes in developing central nervous system (neurotoxicity). Recently, a new area of research has been developed in order to recognize any possible actions that can attenuate anaesthetics neurotoxicity. This review aims to provide an overview of the recent literature on neuroprotection.

Recent findings Neuroprotection includes a variety of actions that aim to preserve neuronal structures and/or function against insults caused by sedative and anaesthetic agents. Neuroprotective solutions include prevention of damage, such as postponing procedure, and counterbalance the damage. Mitigation of the neurotoxicity can be obtained through pharmacological protection, reducing cumulative dose or promoting neuroplasticity. Moreover, surgery and pain themselves might interfere with normal neurodevelopment in children and, in particular, treatment of pain plays a key role in preserving cortical activity and brain development.

Summary Recent literature largely explores a variety of solutions in order to preserve and reduce the damage caused by anaesthetic agents. At the moment, none of the presented solutions regarding neuroprotection is applicable in clinical setting. Further research studies are needed.

aDepartment of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK

bDepartment of Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy

Correspondence to Nicola Disma, MD, Department of Anesthesia, Istituto Giannina Gaslini, Via G. Gaslini 5, 16100 Genoa, Italy. E-mail: nicoladisma@icloud.com

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