General anaesthesia, the developing brain, and cerebral white matter alterations: a narrative review

Wu, Ziyi; Yu, Weiwei; Song, Yanhong; Zhao, Ping

doi:10.1016/j.bja.2023.09.008

Cited by 5 publications

(3 citation statements)

References 66 publications

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“…Several of these studies have confirmed links between such exposure and negative outcomes, indicating the possible neurotoxic effects of different general anesthetics in infants and young children. Very recently, the impact of GA on cerebral white matter in the developing brain was emphasized [31]. The connectivity established by white matter tracts between brain regions is essential for integrating and coordinating neural activity, playing an important role in cognitive and behavioral functions.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Dorsal Penile Nerve Block in Children: An Anatomical-Based Observational Study of a New Anesthesia Technique

Zadrazil,

Feigl,

Opfermann

et al. 2023

Children

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Dorsal penile nerve block stands out as one of the commonly employed regional anesthetic techniques in children. Despite the large body of experience, failure rates are still significant. We included 20 children (median (SD) age of 73 (31) months) scheduled for circumcision without general anesthesia and secondary airway manipulation in a consecutive case series. Under ultrasound guidance and utilizing an in-plane needle guidance technique, the dorsal penile nerve block was administered with slight sedation, and spontaneous respiration was maintained in all cases. To investigate the underlying anatomy for dorsal penile nerve blockade, we dissected three cadavers. The primary study endpoint was the success rate of surgical blockade, meaning that the surgical procedure could be performed without additional general anesthesia and invasive airway management. The secondary endpoint was the requirement of analgesics until discharge from the post-anesthesia care unit. The primary endpoint was successfully met in all patients according to our strict definition without additional general anesthesia or airway manipulation. In addition, no child received analgesics until discharge from the recovery room. The anatomical investigation clarified the specific anatomy as baseline knowledge for an ultrasound-guided dorsal penile nerve blockade and enabled successful performance in 20 consecutive children where penile surgery was possible in light sedation without additional airway manipulation.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Dorsal Penile Nerve Block in Children: An Anatomical-Based Observational Study of a New Anesthesia Technique

Zadrazil,

Feigl,

Opfermann

et al. 2023

Children

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“…These findings suggest that inhalational anesthetics may exert an inhibitory effect on the survival and function of oligodendrocytes. Given that over half of the brain’s volume is white matter, composed of nerve fiber bundles sheathed in myelin produced and maintained by oligodendrocytes ( Wu et al, 2023 ), the implications of this inhibition are considerable. Studies have revealed a correlation between repeated exposure to anesthesia for surgery and an increased risk of ADHD in children ( Warner et al, 2018 ), a disorder linked to myelin degradation in white matter microstructures ( Ameis et al, 2016 ).…”

Section: Evidence From Pre-clinical and Clinical Studiesmentioning

confidence: 99%

General anesthetic agents induce neurotoxicity through oligodendrocytes in the developing brain

Hang,

Yang,

et al. 2024

Zoological Research

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General anesthetic agents can impact brain function through interactions with neurons and their effects on glial cells. Oligodendrocytes perform essential roles in the central nervous system, including myelin sheath formation, axonal metabolism, and neuroplasticity regulation. They are particularly vulnerable to the effects of general anesthetic agents resulting in impaired proliferation, differentiation, and apoptosis. Neurologists are increasingly interested in the effects of general anesthetic agents on oligodendrocytes. These agents not only act on the surface receptors of oligodendrocytes to elicit neuroinflammation through modulation of signaling pathways, but also disrupt metabolic processes and alter the expression of genes involved in oligodendrocyte development and function. In this review, we summarize the effects of general anesthetic agents on oligodendrocytes. We anticipate that future research will continue to explore these effects and develop strategies to decrease the incidence of adverse reactions associated with the use of general anesthetic agents.

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“…In the past two decades, a growing number of researchers have devoted to uncover the underlying mechanisms of anesthesia-related neurodevelopmental toxicity, and their publications are rapidly becoming invaluable sources of information for clinical use [11][12][13][14]. However, few systematic analyses of these publications have been performed, and the key milestones and emerging trends of relevant knowledge are inexplicable [15].…”

Section: Introductionmentioning

confidence: 99%

Global Trends and Hotspots in Pediatric Anesthetic Neurotoxicity Research: A Bibliometric Analysis From 2000 to 2023

Li,

Tan,

Chen

et al. 2024

Cureus

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The impact of general anesthetics on brain function development is one of the top frontier issues of public concern. However, little bibliometric analysis has investigated this territory systematically. Our study aimed to visualize the publications between 2000 and 2023 to inspire the trends and hotspots in anesthetic neurodevelopmental toxicity research. Publications from 2000 to 2023 were collected from the Web of Science Core Collection. CiteSpace was utilized to plot and analyze the network maps of countries, institutions, authors, journals, and keywords associated with these publications. A total of 864 publications, consisting of 786 original articles and 78 reviews, were extracted from 2000 to 2023. The annual publications have increased constantly over the past two decades. The USA and the People's Republic of China were the leading driving forces in this field. Harvard University was the most productive institution. Zhang Y published the most related articles, and Jevtovic-Todorovic V was mostly cited in this field. The most prolific journal was Pediatric Anesthesia, and the most frequently co-cited journal was Anesthesiology. Keywords were divided into nine clusters: "apoptosis", "propofol", "developing brain", "cognitive dysfunction", "neuronal cell degeneration", "brain", "neuroinflammation", "local anesthesia", and "oxygen therapy". The strongest citation bursts in earlier years were "learning disability", "cell death", and "cognitive function". The emerging trends in the coming years were "awake regional anesthesia", "behavioral outcome", and "infancy general anesthesia compared to spinal anesthesia". We conclude that anesthetic-induced neurotoxicity has received growing attention in the past two decades. Our findings evaluated the present status and research trends in this area, which may provide help for exploring further potential prospects on hot topics and frontiers.

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General anaesthesia, the developing brain, and cerebral white matter alterations: a narrative review

Cited by 5 publications

References 66 publications

Ultrasound-Guided Dorsal Penile Nerve Block in Children: An Anatomical-Based Observational Study of a New Anesthesia Technique

Ultrasound-Guided Dorsal Penile Nerve Block in Children: An Anatomical-Based Observational Study of a New Anesthesia Technique

General anesthetic agents induce neurotoxicity through oligodendrocytes in the developing brain

Global Trends and Hotspots in Pediatric Anesthetic Neurotoxicity Research: A Bibliometric Analysis From 2000 to 2023

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