Abstract
Perioperative cerebral damage can result in various clinical sequela ranging from minor neurocognitive deficits to catastrophic neurological morbidity with permanent impairment and death. The goal of neuroprotective treatments is to reduce the clinical effects of cerebral damage through two major mechanisms: increased tolerance of neurological tissue to ischemia and changes in intra-cellular responses to energy supply deprivation. In this review, we present the clinical evidence of intravenous anesthetics on perioperative neuroprotection, and we also provide a critical perspective for future studies. The neuroprotective efficacy of the intravenous anesthetics thiopental, propofol and etomidate is unproven. Lidocaine may be neuroprotective in non-diabetic patients who have undergoing cardiac surgery with cardiopulmonary bypass (CBP) or with a 48-hour infusion, but conclusive data are lacking. There are several limitations of clinical studies that evaluate postoperative cognitive dysfunction (POCD), including difficulties in identifying patients at high-risk and a lack of consensus for defining the “gold-standard” neuropsychological testing. Although a battery of neurocognitive tests remains the primary method for diagnosing POCD, recent evidence suggests a role for novel biomarkers and neuroimaging to preemptively identify patients more susceptible to cognitive decline in the perioperative period. Current evidence, while inconclusive, suggest that intravenous anesthetics may be both neuroprotective and neurotoxic in the perioperative period. A critical analysis on data recorded from randomized control trials (RCTs) is essential in identifying patients who may benefit or be harmed by a particular anesthetic. RCTs will also contribute to defining methodologies for future studies on the neuroprotective effects of intravenous anesthetics.
Keywords: Neuroprotection, intravenous anesthetic, neurotoxicity, neuropsychological testing.
Current Pharmaceutical Design
Title:Neuroprotective Effects of Intravenous Anesthetics: A New Critical Perspective
Volume: 20 Issue: 34
Author(s): Federico Bilotta, Elisabetta Stazi, Alexander Zlotnik, Shaun E. Gruenbaum and Giovanni Rosa
Affiliation:
Keywords: Neuroprotection, intravenous anesthetic, neurotoxicity, neuropsychological testing.
Abstract: Perioperative cerebral damage can result in various clinical sequela ranging from minor neurocognitive deficits to catastrophic neurological morbidity with permanent impairment and death. The goal of neuroprotective treatments is to reduce the clinical effects of cerebral damage through two major mechanisms: increased tolerance of neurological tissue to ischemia and changes in intra-cellular responses to energy supply deprivation. In this review, we present the clinical evidence of intravenous anesthetics on perioperative neuroprotection, and we also provide a critical perspective for future studies. The neuroprotective efficacy of the intravenous anesthetics thiopental, propofol and etomidate is unproven. Lidocaine may be neuroprotective in non-diabetic patients who have undergoing cardiac surgery with cardiopulmonary bypass (CBP) or with a 48-hour infusion, but conclusive data are lacking. There are several limitations of clinical studies that evaluate postoperative cognitive dysfunction (POCD), including difficulties in identifying patients at high-risk and a lack of consensus for defining the “gold-standard” neuropsychological testing. Although a battery of neurocognitive tests remains the primary method for diagnosing POCD, recent evidence suggests a role for novel biomarkers and neuroimaging to preemptively identify patients more susceptible to cognitive decline in the perioperative period. Current evidence, while inconclusive, suggest that intravenous anesthetics may be both neuroprotective and neurotoxic in the perioperative period. A critical analysis on data recorded from randomized control trials (RCTs) is essential in identifying patients who may benefit or be harmed by a particular anesthetic. RCTs will also contribute to defining methodologies for future studies on the neuroprotective effects of intravenous anesthetics.
Export Options
About this article
Cite this article as:
Bilotta Federico, Stazi Elisabetta, Zlotnik Alexander, Gruenbaum E. Shaun and Rosa Giovanni, Neuroprotective Effects of Intravenous Anesthetics: A New Critical Perspective, Current Pharmaceutical Design 2014; 20 (34) . https://dx.doi.org/10.2174/1381612820666140325110113
DOI https://dx.doi.org/10.2174/1381612820666140325110113 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
The Role of Ultrasonography of Peripheral Entheses in the Diagnosis and Assessment of Spondyloarthropathies
Current Rheumatology Reviews Antihemostatic Strategies of Blood-Feeding Arthropods
Current Drug Targets - Cardiovascular & Hematological Disorders A Brief Review of Blue- and Bilberries’ Potential to Curb Cardio-Metabolic Perturbations: Focus on Diabetes
Current Pharmaceutical Design Relevance of the Vascular Effects of Insulin in the Rationale of its Therapeutical Use
Cardiovascular & Hematological Disorders-Drug Targets Physiological Mechanisms of Action of Incretin and Insulin in Regulating Skeletal Muscle Metabolism
Current Diabetes Reviews Benefits of Exercise Training in Secondary Prevention of Coronary and Peripheral Arterial Disease
Vascular Disease Prevention (Discontinued) Assessing Coronary Blood Flow Physiology in the Cardiac Catheterisation Laboratory
Current Cardiology Reviews The Synthetic Cannabinoids Phenomenon
Current Pharmaceutical Design Obesity, Metabolic Syndrome, Diabetes and Arterial Hypertension
Immunology, Endocrine & Metabolic Agents in Medicinal Chemistry (Discontinued) Surgical Treatment of Neonatal Mastitis by Periareolar Drainage
Current Pediatric Reviews Recent Patents on Ocular Drug Delivery Systems
Recent Patents on Drug Delivery & Formulation Fabrication and Characterization of Ocular Phase Transition Systems for Blepharitis: A Novel Approach
Drug Delivery Letters Protective Effects of Diuretics Against the Development of Cardiovascular Disease in Patients with Chronic Kidney Disease: A Systematic Review
Cardiovascular & Hematological Agents in Medicinal Chemistry Myocardial Contrast Echocardiography: Role in Clinical Cardiology
Current Vascular Pharmacology Comparative Study of Eudragit RS 100 and RL 100 Nanoparticles as Ophthalmic Vehicle for Fungal Infection
Pharmaceutical Nanotechnology The Role of Omega-3 Polyunsaturated Fatty Acids Supplementation in Childhood: A Review
Recent Patents on Cardiovascular Drug Discovery Determination of Phytochemicals by GC-MS in Two Fractions (17 and 21) of Methanol Extract of Loranthus Micranthus and their Antioxidant and Anti-Inflammatory Activity
The Natural Products Journal Latest Advances in Breast Sonography
Recent Patents on Medical Imaging Herpes Simplex Virus-Induced Ocular Diseases: Detrimental Interaction Between Virus and Host
Current Immunology Reviews (Discontinued) Development and Optimization of Controlled Release Bioerodable Anti Infective Ophthalmic Insert
Current Drug Delivery