Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2012
Feasibility and pilot study of the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project.
Animal studies have documented that exposure of the developing brain to commonly used anesthetic agents induces neurotoxicity and late abnormal neurobehavioral functions as adults. Results from clinical studies have all been analyzed using existing data sets, and these studies produced inconsistent results. To provide more definitive evidence to address the clinical relevance of anesthetic neurotoxicity in children, an interdisciplinary team of investigators designed and developed the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project. We present pilot study results in 28 sibling pairs recruited and tested at the Columbia University Medical Center (CUMC) and Children's Hospital of Boston (CHB) for the PANDA project. ⋯ The pilot study provided useful information for feasibility to recruit the sample size and to obtain relevant clinical data. For the final study protocol, both the neuropsychological battery and the age range for testing were revised. Our results confirmed the feasibility of our study approach and yielded pilot data from neuropsychological testing.
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J Neurosurg Anesthesiol · Oct 2012
ReviewPreclinical research into the effects of anesthetics on the developing brain: promises and pitfalls.
Every year millions of children are treated with anesthetics and sedatives to alleviate pain and distress during invasive procedures. Accumulating evidence suggests the possibility for deleterious effects on the developing brain. ⋯ Accordingly, this review summarizes the current state of animal research in this field, introduces some of the findings presented at the PANDA symposium, and addresses some of the difficulties in translating these findings to pediatric anesthesia practice, as discussed during the symposium. The symposium participants' consensus was that significant preclinical and clinical research efforts are still needed to investigate this important concern for child health.
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J Neurosurg Anesthesiol · Oct 2012
Anesthetics interfere with the polarization of developing cortical neurons.
Numerous studies from the clinical and preclinical literature indicate that general anesthetic agents have toxic effects on the developing brain, but the mechanism of this toxicity is still unknown. Previous studies have focused on the effects of anesthetics on cell survival, dendrite elaboration, and synapse formation, but little attention has been paid to possible effects of anesthetics on the developing axon. Using dissociated mouse cortical neurons in culture, we found that isoflurane delays the acquisition of neuronal polarity by interfering with axon specification. ⋯ Rather, the delay in axon specification likely results from a slowing of the extension of prepolarized neurites. The effect is not unique to isoflurane as propofol also seems to interfere with the acquisition of neuronal polarity. These findings demonstrate that anesthetics may interfere with brain development through effects on axon growth and specification, thus introducing a new potential target in the search for mechanisms of pediatric anesthetic neurotoxicity.
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J Neurosurg Anesthesiol · Oct 2012
Historical ArticleThe history of neuroanesthesiology: the people, pursuits, and practices.
Neuroanesthesiology has a rich history. Although advances in research and clinical practice were cornerstones for the development of this field, other equally critical factors came into play. ⋯ This article reviews important advances within the subspecialty and many individuals behind those advances. The analysis and speculative synthesis provide insights into the current status of neuroanesthesiology and possible directions for the subspecialty's future.
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J Neurosurg Anesthesiol · Oct 2012
Sevoflurane and isoflurane preconditioning provides neuroprotection by inhibition of apoptosis-related mRNA expression in a rat model of focal cerebral ischemia.
This study aimed to examine the effects of sevoflurane or isoflurane preconditioning on cerebral ischemia/reperfusion-induced inflammation, oxidative stress, and lipid peroxidation and test the hypothesis that the underlining mechanism of the protective effect of preconditioning involves changes in the apoptotic gene expression profiles in an experimental model of middle cerebral artery occlusion in rats. ⋯ Sevoflurane and isoflurane preconditioning ameliorates inflammation, cerebral lipid peroxidation, and histologic injury. Downregulation of proapoptotic molecules and upregulation of antiapoptotic molecules may be associated with this effect.