Anesthetics and brain protection.
OBJECTIVE
There is a considerable risk of cerebral ischemia during anesthesia and surgery. Anesthetic agents have been shown to have a profound effect on the pathophysiology of cerebral ischemia. The present review provides a brief historical review and details new information about the anesthetic effects on the ischemic brain.


RESULTS
Although anesthetics have been shown to reduce ischemic cerebral injury, the durability of this neuroprotection has been questioned. Recent data indicate that, under the right circumstances, anesthetic neuroprotection can be sustained for at least 2-4 weeks; the durability of this protection is dependent upon the experimental model, control of physiologic parameters and the assurance of the adequacy of reperfusion. In addition, volatile anesthetics have been shown to accelerate postischemic neurogenesis; this suggests that anesthetics may enhance the endogenous reparative processes in the injured brain.


CONCLUSIONS
The available data indicate that anesthetics can provide long-term durable protection against ischemic injury that is mild to moderate in severity. Experimental data do not provide support for the premise that anesthetics reduce injury when the ischemic injury is severe.
Head
Brian P
BP
Department of Anesthesiology, University of California-San Diego, CA, USA. ppatel@ucsd.edu
Patel
Piyush
P
D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000494:pharmacology; D001921:Brain / Q000187:drug effects; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D018696:Neuroprotective Agents / Q000494:pharmacology*; D013997:Time Factors
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D018696:Neuroprotective Agents