Effect of General Anaesthesia on the Developing Brain: a Pilot Study
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 6, Pages 323-331
Abstract
Anaesthesiology is still a young yet growing specialty, especially regarding its long-term effects on the pediatric population and their developing brain. The delayed effects are still under study because potential interventions cannot be studied directly on humans especially on the pediatric population. Anesthesia in newborn infants is sometimes necessary as newborn infants may require surgeries that can not be postponed. Although the development of the brain begins during the last semester of intrauterine life, the brain is not fully developed at birth and continues to grow up to the age of 2 years. It has been studied and widely accepted that the commonly used general anesthetics potentiate inhibitory transmission through gamma-amino-butyric-acid type A (GABAA) receptors and the excitatory transmission is reduced through N-methyl-D-aspartic acid (NMDA) glutamate receptors causing widespread apoptotic neurodegeneration.1The adverse effect of halothane on the developing brain was reported some two decades ago when it was studied and accepted that long-term exposure to an inhalational agent like halothane, beginning in utero and continuing for several days in the postnatal period, caused impairment of synaptogenesis, reduction in dendritic branching, suppressed axonal growth and reduced myelinated nerves in rodents.2 Studies in some young animals and human primates have shown that several drugs used for general anesthesia, at therapeutic concentrations used for anesthesia, killed cells, and produce neurodegeneration much before anesthesia when the brain is undergoing developmental changes.1 Studies done on the adults have shown that GABAA receptor activation leads to an influx of chloride ions (Cl–) into the cell, this results in hyperpolarization and can lead to neuroprotection in many models during the period of hypoxia, ischemia, and other forms of cerebral insults. However, during the early stage of life when the brain is still developing, especially during synaptogenesis, the intracellular concentration of Cl– is high; activation of GABAA receptor may result in Cl– efflux, and depolarization of neurons.2As per the above studies, there are chances that general anesthesia including halothane can affect the developing brain of young children. In this retrospective observational study, we intended to study the effect of general anesthesia using halothane predominantly on the developing brain of young children undergoing surgery for cleft lip, cleft palate, or both.
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