Neuroprotection During Anesthesia and Surgery

Abstract

General anesthesia is viewed from two angles in this chapter: adverse effects on the brain and use of some anesthetic agents as neuroprotectives, with focus on the latter. There is a particular concern about neurotoxicity of general anesthetics on the developing brain during anesthesia in pregnant women. Neurological complications of general anesthesia have been described elsewhere (Jain 2010b). General anesthesia carries a risk of stroke in elderly hypertensive patients, particularly in those with stenotic lesions of the cerebral arteries and those with incidental or induced hypotension. This is more to do with techniques and the physiological responses, which may result in hypotension or inadequate oxygenation. In spite of all the modern monitoring techniques, it is not possible to avoid an episode of cerebrovascular ischemia during general anesthesia. Complications of carotid endarterectomy during local or regional anesthesia are distinctly less than those under general anesthesia. One of the reasons is that general anesthesia deprives the possibility of clinical neurological assessment requiring patient cooperation and responses. However, agents used for anesthesia have a neuroprotective effect, which will be discussed in the following section.