Understanding pharmaceutical agents used in neuroanesthesia

Annually, millions of surgeries are carried out worldwide under general anesthesia. Physicochemical and pharmacological properties differ between anesthetic drugs. Different molecular reactions within the human body are triggered by surgery and anesthesia. Cellular protective mechanisms against any kind of insult may be either enhanced or attenuated under general anesthesia. In addition, patients undergoing neurosurgery may be a heightened risk of neurotoxicity from anesthetic drugs. Extensive literature supporting neurotoxic effects of anesthetic drugs has been published in animal models including nonhuman primates, whereas human data are limited. Surgery and anesthesia exposure may be related to a higher incidence of neurological dysfunction mostly in extreme age patients (children and older patients). Postoperative cognitive dysfunction, delirium, and progression of previously diagnosed neurodegenerative disorders are some of the unsatisfactory clinical outcomes. However, some anesthetics exhibit neuroprotection properties and can even blunt neurotoxicity properties of other anesthetics when used in combination. Drug-drug interactions are possible when undergoing anesthesia as patients can be on multiple medications prior to surgery which can enhance neurotoxicities. There are multiple variables to consider to decrease the risk of neurotoxicity and potentially provide neuroprotection when it comes to anesthetics agents.