title: Anesthesia, brain changes, and behavior: Insights from neural systems biology.
abstract: Long-term consequences of anesthetic exposure in humans are not well understood. It is possible that alterations in brain function occur beyond the initial anesthetic administration. Research in children and adults has reported cognitive and/or behavioral changes after surgery and general anesthesia that may be short lived in some patients, while in others, such changes may persist. The changes observed in humans are corroborated by a large body of evidence from animal studies that support a role for alterations in neuronal survival (neuroapoptosis) or structure (altered dendritic and glial morphology) and later behavioral deficits at older age after exposure to various anesthetic agents during fetal or early life. The potential of anesthetics to induce long-term alterations in brain function, particularly in vulnerable populations, warrants investigation. In this review, we critically evaluate the available preclinical and clinical data on the developing and aging brain, and in known vulnerable populations to provide insights into potential changes that may affect the general population of patients in a more, subtle manner. In addition this review summarizes underlying processes of how general anesthetics produce changes in the brain at the cellular and systems level and the current understanding underlying mechanisms of anesthetics agents on brain systems. Finally, we present how neuroimaging techniques currently emerge as promising approaches to evaluate and define changes in brain function resulting from anesthesia, both in the short and the long-term.
authors.affiliation: Center for Pain and the Brain, 1 Autumn Street, Boston Children's Hospital, Boston MA 02115, United States; Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States. Electronic address: elisabeth.colon@childrens.harvard.edu.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Colon
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
authors.affiliation: Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States.
authors.forename: Barry
authors.initials: B
authors.lastname: Kussman
authors.affiliation: Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: McCann
authors.affiliation: Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States.
authors.forename: Sulpicio
authors.initials: S
authors.lastname: Soriano
authors.affiliation: Center for Pain and the Brain, 1 Autumn Street, Boston Children's Hospital, Boston MA 02115, United States; Department of Anesthesia, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States.
authors.forename: David
authors.initials: D
authors.lastname: Borsook
mesh_terms: D000375:Aging / Q000187:drug effects*; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects*; D000818:Animals; D001519:Behavior / Q000187:drug effects; D001921:Brain / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000503:physiopathology*; D019317:Evidence-Based Medicine; D006801:Humans; D001523:Mental Disorders / Q000139:chemically induced* / Q000503:physiopathology*; D008959:Models, Neurological
chemical_list: D000777:Anesthetics
keywords: Aging and developing brain; Anesthetics; Apoptosis; Functional imaging; Neurocognitive outcome; Toxicity