| Abstract [eng] |
This literature review explores the effects of general anesthesia on infant brain development, emphasizing potential neurocognitive and structural consequences. Given the rapid and complex nature of brain maturation in early life, concerns have emerged regarding anesthesia-induced neurotoxicity, particularly in relation to synaptic development, neuronal apoptosis, and long-term cognitive function. The developing brain is highly plastic and undergoes rapid changes, making it particularly susceptible to external influences, including anesthetic agents. General anesthetics primarily act on γ-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA) receptors, disrupting normal synaptic activity and potentially leading to widespread neuronal apoptosis, synaptic dysfunction, and neuroinflammation. While animal studies have consistently demonstrated significant neurotoxic effects, including neuronal apoptosis, structural changes and major neurocognitive alterations, human studies present more variable and less pronounced findings. Neurocognitive and behavioural outcomes following anesthesia exposure in infancy remain a topic of debate. Large-scale human studies such as the GAS, PANDA, and MASK trials indicate that a single, short exposure does not significantly impact intelligence quotient or broad cognitive function. However, repeated or prolonged exposures have been associated with deficits in memory, executive function, and behavioural regulation. Epidemiological data suggest an increased incidence of neurodevelopmental disorders, including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders, in children with multiple early-life anesthetic exposures. These findings highlight the need for further research into the precise mechanisms underlying anesthesia-induced neurotoxicity and its long-term consequences. Given these concerns, potential mitigation strategies have been explored. Research into molecular pathways suggests that pharmacological interventions may offer neuroprotective benefits. Alternative anesthetic techniques, such as regional anesthesia, opioid adjuncts, and multimodal analgesia, may help reduce the reliance on high-dose general anesthetics in pediatric procedures. While current evidence does not support the routine postponement of necessary surgeries, careful risk-benefit assessment is crucial, particularly for elective procedures. Future research should focus on identifying at-risk populations, optimizing anesthetic protocols, and developing targeted neuroprotective interventions to ensure safer outcomes for infants undergoing anesthesia. |
