title: Neuroprotection and neurotoxicity in the developing brain: an update on the effects of dexmedetomidine and xenon.
abstract: Growing and consistent preclinical evidence, combined with early clinical epidemiological observations, suggest potentially neurotoxic effects of commonly used anesthetic agents in the developing brain. This has prompted the FDA to issue a safety warning for all sedatives and anesthetics approved for use in children under three years of age. Recent studies have identified dexmedetomidine, the potent α2-adrenoceptor agonist, and xenon, the noble gas, as effective anesthetic adjuvants that are both less neurotoxic to the developing brain, and also possess neuroprotective properties in neonatal and other settings of acute ongoing neurologic injury. Dexmedetomidine and xenon are effective anesthetic adjuvants that appear to be less neurotoxic than other existing agents and have the potential to be neuroprotective in the neonatal and pediatric settings. Although results from recent clinical trials and case reports have indicated the neuroprotective potential of xenon and dexmedetomidine, additional randomized clinical trials corroborating these studies are necessary. By reviewing both the existing preclinical and clinical evidence on the neuroprotective effects of dexmedetomidine and xenon, we hope to provide insight into the potential clinical efficacy of these agents in the management of pediatric surgical patients.
authors.affiliation: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Alam
authors.affiliation: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK.
authors.forename: Ka Chun
authors.initials: KC
authors.lastname: Suen
authors.affiliation: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK.
authors.forename: Zac
authors.initials: Z
authors.lastname: Hana
authors.affiliation: Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Sanders
authors.affiliation: Department of Anesthesia and Perioperative Care, University California San Francisco, CA, USA.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Maze
authors.affiliation: Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK. Electronic address: d.ma@imperial.ac.uk.
authors.forename: Daqing
authors.initials: D
authors.lastname: Ma
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000494:pharmacology; D000818:Animals; D001921:Brain / Q000187:drug effects / Q000254:growth & development; D020927:Dexmedetomidine / Q000494:pharmacology*; D006801:Humans; D008959:Models, Neurological; D018696:Neuroprotective Agents / Q000494:pharmacology*; D020258:Neurotoxicity Syndromes / Q000517:prevention & control*; D014978:Xenon / Q000494:pharmacology*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D018685:Anesthetics, Inhalation; D018696:Neuroprotective Agents; D014978:Xenon; D020927:Dexmedetomidine
keywords: Anesthesia; Dexmedetomidine; Neuroprotection; Neurotoxicity; Pediatric; Xenon