Rizk Abanoub Aziz, Plitman Eric, Senthil Pooja, Venkatraghavan Lashmi, Chowdhury Tumul
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Can J Neurol Sci. 2023 Nov;50(6):897-904. doi: 10.1017/cjn.2022.319. Epub 2022 Nov 10.
The blood brain barrier (BBB) is a highly selective permeable barrier that separates the blood and the central nervous system. Anesthesia is an integral part of surgery, and there is little known about the impact of anesthetics on the BBB. Therefore, it is imperative to explore reversible or modifiable variables such as anesthetic agents that influence BBB integrity. We aimed to synthesize the literature pertaining to the various effects of anesthetics on the BBB.
MEDLINE, Embase, and Cochrane were searched from inception up to September 2022.
A total of 14 articles met inclusion into the review. The articles included nine randomized control studies (64.3%) and five quasi-experimental studies (35.7%). Twelve studies used volatile anesthetics, one study used fentanyl intravenously, and one study used pentobarbital or ketamine intraperitoneally. BBB structural deficits following the administration of an anesthetic agent included ultrastructural deficits, decreases in tight junctions, and decreases in BBB components. BBB functional deficits included permeability increases following exposure to volatile anesthetics. However, two studies found decreased permeability after fentanyl, pentobarbital, or ketamine exposure. Moreover, the impact of anesthetics on the BBB seems to be related to the duration of exposure. Notably, study findings also suggest that changes following anesthetic exposure demonstrate some reversibility over the short-term.
Overall, our systematic review highlights interesting findings pertaining to the impact of anesthetic agents on BBB integrity in previously healthy models. These findings and mechanisms should inspire future work to aid practitioners and healthcare teams potentially better care for patients.
血脑屏障（BBB）是一种高度选择性的渗透屏障，将血液与中枢神经系统分隔开来。麻醉是手术不可或缺的一部分，而关于麻醉剂对血脑屏障的影响却知之甚少。因此，探索诸如麻醉剂等影响血脑屏障完整性的可逆或可调节变量势在必行。我们旨在综合有关麻醉剂对血脑屏障各种影响的文献。
检索MEDLINE、Embase和Cochrane数据库，时间跨度从建库至2022年9月。
共有14篇文章符合纳入本综述的标准。这些文章包括9项随机对照研究（64.3%）和5项准实验研究（35.7%）。12项研究使用了挥发性麻醉剂，1项研究静脉使用了芬太尼，1项研究腹腔注射了戊巴比妥或氯胺酮。给予麻醉剂后血脑屏障的结构缺陷包括超微结构缺陷、紧密连接减少以及血脑屏障成分减少。血脑屏障的功能缺陷包括接触挥发性麻醉剂后通透性增加。然而，两项研究发现，接触芬太尼、戊巴比妥或氯胺酮后通透性降低。此外，麻醉剂对血脑屏障的影响似乎与暴露持续时间有关。值得注意的是，研究结果还表明，麻醉暴露后的变化在短期内具有一定的可逆性。
总体而言，我们的系统综述突出了有关麻醉剂对既往健康模型中血脑屏障完整性影响的有趣发现。这些发现和机制应激发未来的研究工作，以帮助从业者和医疗团队可能更好地照顾患者。
