• Skip to content
  • Skip to primary sidebar
  • Collections
  • ECG Library
  • Top 100
  • PART ONE
  • CASES
  • CCC
  • Tox Library

Life in the Fast Lane • LITFL • Medical Blog

Emergency medicine and critical care medical education blog

Critical Care Compendium | Effects of Anaesthetic Agents on the Developing Brain

Effects of Anaesthetic Agents on the Developing Brain

by Chris Nickson, Last updated June 28, 2013

OVERVIEW

  • There is concern that sedatives and anaesthetic agents may have harmful effects on the developing brain

MECHANISMS OF NEUROTOXICTY

NMDA antagonists and GABA agonists both trigger neuronal apoptosis in experimental infant animals via both:

  • receptor upregulation following blockade resulting in overexcitation
  • decreased trophic stimulation

Effects are:

  • dose and time dependent
  • shown for all sedative/anaesthetic agents in animal studies
  • worse with agents or combinations that work via both NMDA and GABA receptor
  • maximal at the time of peak synaptogenesis (in humans this is 20-26 weeks gestation)

It is unclear whether these agents speed up normal apoptosis or trigger new events

EVIDENCE

  • Direct evidence in humans lacking but some evidence that early exposure to anaesthesia may result in learning problems later in life
  • There is also evidence that pain may promote neuronal apoptosis at least as severe as anaesthetic agents
  • paradoxically, ketamine has also been found to have neuroprotective effects in some studies
  • No current guidelines on what to do in light of the above findings

CLINICAL IMPLICATIONS

  • uncertain
  • direct evidence based on animal studies (mainly rat pups at high doses) and may not be applicable in the clinical setting
  • Limiting exposure seems sensible
  • consider limiting the use of  combinations of NMDA antagonists and GABA agonists
  • overall the benefits of using these agents currently outweighs the risks

References and Links

  • Sun, L. Early childhood general anaesthesia exposure and neurocognitive development. Br. J. Anaesth. (2010) 105 (suppl 1): i61-i68.doi: 10.1093/bja/aeq302 [Free Full Text]
  • Rappaport B, Mellon RD, Simone A, Woodcock J. Defining safe use of anesthesia in children. N Engl J Med. 2011 Apr 14;364(15):1387-90. doi: 10.1056/NEJMp1102155. Epub 2011 Mar 9. PubMed PMID: 21388302.  [Free Full Text]
  • Green SM, Coté CJ. Ketamine and neurotoxicity: clinical perspectives and implications for emergency medicine. Ann Emerg Med. 2009 Aug;54(2):181-90. doi: 10.1016/j.annemergmed.2008.10.003. Epub 2008 Nov 6. Review. PubMed PMID: 18990467.

Share this:

  • Facebook
  • LinkedIn
  • Twitter

About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

All LITFL posts by EMAIL or RSS

LITFL Weekly review by EMAIL or RSS

Frivolous Friday Five by EMAIL or RSS

Copyright © 2007 - 2019 · Powered by vocortex and iSimulate

We use cookies to understand site usage and to improve the content and offerings on our sites. If you continue using our website, we'll assume that you are happy to receive all cookies on this website.