Pharmacology, Toxicology and Clinical Pharmacology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Brain Res Bull. 2020 Dec;165:281-289. doi: 10.1016/j.brainresbull.2020.10.011. Epub 2020 Oct 17.
Since their first use, anaesthetic agents have seen major advancements and are now an indispensable element of surgical procedures. Two of the most used volatile anaesthetics are isoflurane and sevoflurane. These have neuroprotective effects on adult brains in different brain disorders, ranging from traumatic to hypoxic or ischemia-reperfusion injuries. In new-borns and elderly patients these effects are reversed, and volatile anaesthetics might have a neurotoxic effect, affecting the recovery and neurological capabilities of these patients. Since we are still using volatile anaesthetics, it is important to know in which conditions these substances are neurotoxic and neuroprotective, as well as to better understand the mechanisms underlying these effects. In this review we aim to summarise the current knowledge on the mechanisms involved in neuroprotection and neurotoxicity of neonatal, adult and aged brains and how these vary based on the brains age and underlying pathologies. This review should guide future experimental research towards less studied mechanisms and should help the development of neuroprotective strategies. Also, we provide a short summary of the substances used in experimental studies to prevent the neurotoxic effect of isoflurane and sevoflurane.
自首次使用以来，麻醉剂已经取得了重大进展，现在是手术过程中不可或缺的一部分。两种最常用的挥发性麻醉剂是异氟烷和七氟烷。它们在不同的脑疾病中对成人的大脑具有神经保护作用，范围从创伤性到缺氧或缺血再灌注损伤。在新生儿和老年患者中，这些作用被逆转，挥发性麻醉剂可能具有神经毒性作用，影响这些患者的恢复和神经功能。由于我们仍在使用挥发性麻醉剂，因此了解这些物质在哪些情况下具有神经毒性和神经保护作用非常重要，并且需要更好地理解这些作用的机制。在这篇综述中，我们旨在总结涉及新生儿、成人和老年大脑神经保护和神经毒性的机制的最新知识，以及这些机制如何根据大脑的年龄和潜在病理而变化。这篇综述应该指导未来对研究较少的机制的实验研究，并有助于开发神经保护策略。此外，我们还提供了用于预防异氟烷和七氟烷神经毒性作用的实验研究中使用的物质的简短摘要。
