A Causal Relationship Between Intravenous And Inhaled Anesthetic Exposure And Brain Development
• 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, including neurodevelopmental impairment.
• Controlled anesthetic exposure is difficult to accomplish when designing studies meant to explore anesthetic neurotoxicity.
• Studies involving twin siblings report a significant genetic socio-economic and environmental influence on neurodevelopmental outcome.
• Secondary outcomes for GAS prospective study were published in 2016. Neurodevelopmental disorders were not identified in 2 year old children, after early anesthetic exposure. GAS study unicity is conferred by sevoflurane controlled anesthesia.
• Short-term neurodevelopmental testing may not be relevant for diagnosis. Long-term testing might as well be challenging because of loss to follow up and migration.
• Prevention, diagnosis…