I. Key Points
• Evidence from animal studies supports a causal relationship between intravenous and inhaled anesthetic exposure and brain development, triggering increased apoptosis, with negative neurocognitive and behavioral outcomes.
• All these negative events take place during a high vulnerability period on brain development known as “brain spurt”.
• Normally, 70% of neurons will undergo apoptosis during brain development. Gamma aminobutyric acid (GABA) and glutamate receptor modulation may be involved in apoptotic pathway signaling. Anesthetic drugs exert their actions through these receptors, among many others, to produce loss of consciousness.
• Delaying non-elective surgical procedures might put children at risk of disease progression, …show more content…
Both NMDA and GABA receptors have been linked to impaired synaptogenesis and increased neuro-apoptosis in alcoholic fetal syndrome (5). Whether or not anesthetic modulation of these neurotransmitter pathways impairs synaptogenesis and/or neurodevelopment in early infancy is still a matter of debate and growing research. Translating results from animal models to clinical practice is challenging, as long as animal research procedures may not reflect the pediatric anesthetic practice (6, 7).
III. Human Brain Development.
Human brain development is a complex and tightly regulated process that starts early in the embryonic period and extends throughout the fetal and postnatal life (8). There is extensive genetic control over early brain development on the anatomic, cellular and molecular levels. Recent research has improved our understanding of the different factors that influence this process. Human brain development is also dynamic and adaptive in nature as well (9). As a result, the brain reaches 90% of its adult size by the age of five (1, 10).
A. Embryonic period (Conception – Week
• Evidence from animal studies supports a causal relationship between intravenous and inhaled anesthetic exposure and brain development, triggering increased apoptosis, with negative neurocognitive and behavioral outcomes.
• All these negative events take place during a high vulnerability period on brain development known as “brain spurt”.
• Normally, 70% of neurons will undergo apoptosis during brain development. Gamma aminobutyric acid (GABA) and glutamate receptor modulation may be involved in apoptotic pathway signaling. Anesthetic drugs exert their actions through these receptors, among many others, to produce loss of consciousness.
• Delaying non-elective surgical procedures might put children at risk of disease progression, …show more content…
Both NMDA and GABA receptors have been linked to impaired synaptogenesis and increased neuro-apoptosis in alcoholic fetal syndrome (5). Whether or not anesthetic modulation of these neurotransmitter pathways impairs synaptogenesis and/or neurodevelopment in early infancy is still a matter of debate and growing research. Translating results from animal models to clinical practice is challenging, as long as animal research procedures may not reflect the pediatric anesthetic practice (6, 7).
III. Human Brain Development.
Human brain development is a complex and tightly regulated process that starts early in the embryonic period and extends throughout the fetal and postnatal life (8). There is extensive genetic control over early brain development on the anatomic, cellular and molecular levels. Recent research has improved our understanding of the different factors that influence this process. Human brain development is also dynamic and adaptive in nature as well (9). As a result, the brain reaches 90% of its adult size by the age of five (1, 10).
A. Embryonic period (Conception – Week