The Role of Intravenous Anesthetics for Neuro: Protection or Toxicity?

Overview

Journal Neurosci Bull

Specialty Neurology

Date 2024 Aug 17

PMID 39153174

Authors

Kaixin Wang

Yafeng Wang

Tianhao Zhang

Bingcheng Chang

Daan Fu

Xiangdong Chen

Affiliations

Soon will be listed here.

Abstract

The primary intravenous anesthetics employed in clinical practice encompass dexmedetomidine (Dex), propofol, ketamine, etomidate, midazolam, and remimazolam. Apart from their established sedative, analgesic, and anxiolytic properties, an increasing body of research has uncovered neuroprotective effects of intravenous anesthetics in various animal and cellular models, as well as in clinical studies. However, there also exists conflicting evidence pointing to the potential neurotoxic effects of these intravenous anesthetics. The role of intravenous anesthetics for neuro on both sides of protection or toxicity has been rarely summarized. Considering the mentioned above, this work aims to offer a comprehensive understanding of the underlying mechanisms involved both in the central nerve system (CNS) and the peripheral nerve system (PNS) and provide valuable insights into the potential safety and risk associated with the clinical use of intravenous anesthetics.

Citing Articles

Dexmedetomidine Reduces Presynaptic γ-Aminobutyric Acid Release and Prolongs Postsynaptic Responses in Layer 5 Pyramidal Neurons in the Primary Somatosensory Cortex of .

Tang B, Tang J, Huang Y Int J Mol Sci. 2025; 26(5).

PMID: 40076557 PMC: 11900034. DOI: 10.3390/ijms26051931.

Sedatives in neurocritical care: the old, the new, the future.

De Sloovere V, Kotfis K, Meyfroidt G Intensive Care Med. 2025; .

PMID: 39961849 DOI: 10.1007/s00134-025-07823-2.

References

Shiomi M, Miyamae M, Takemura G, Kaneda K, Inamura Y, Onishi A . Induction of autophagy restores the loss of sevoflurane cardiac preconditioning seen with prolonged ischemic insult. Eur J Pharmacol. 2013; 724:58-66. DOI: 10.1016/j.ejphar.2013.12.027. View

Schippers F, Pesic M, Saunders R, Borkett K, Searle S, Webster L . Randomized Crossover Trial to Compare Abuse Liability of Intravenous Remimazolam Versus Intravenous Midazolam and Placebo in Recreational Central Nervous System Depressant Users. J Clin Pharmacol. 2020; 60(9):1189-1197. PMC: 7496124. DOI: 10.1002/jcph.1614. View

Bartels M, Althoff R, Boomsma D . Anesthesia and cognitive performance in children: no evidence for a causal relationship. Twin Res Hum Genet. 2009; 12(3):246-53. DOI: 10.1375/twin.12.3.246. View

Zhang T, Ji D, Sun J, Song J, Nie L, Sun N . NPAS4 suppresses propofol-induced neurotoxicity by inhibiting autophagy in hippocampal neuronal cells. Arch Biochem Biophys. 2021; 711:109018. DOI: 10.1016/j.abb.2021.109018. View

Qiao H, Li Y, Xu Z, Li W, Fu Z, Wang Y . Propofol Affects Neurodegeneration and Neurogenesis by Regulation of Autophagy via Effects on Intracellular Calcium Homeostasis. Anesthesiology. 2017; 127(3):490-501. PMC: 5561483. DOI: 10.1097/ALN.0000000000001730. View

Amiot J, Bouju P, Palacci J, Balliner E . Intravenous regional anaesthesia with ketamine. Anaesthesia. 1985; 40(9):899-901. DOI: 10.1111/j.1365-2044.1985.tb11056.x. View

Turan A, Duncan A, Leung S, Karimi N, Fang J, Mao G . Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trial. Lancet. 2020; 396(10245):177-185. DOI: 10.1016/S0140-6736(20)30631-0. View

Peng X, Li C, Yu W, Liu S, Cong Y, Fan G . Propofol Attenuates Hypoxia-Induced Inflammation in BV2 Microglia by Inhibiting Oxidative Stress and NF-B/Hif-1 Signaling. Biomed Res Int. 2020; 2020:8978704. PMC: 7204316. DOI: 10.1155/2020/8978704. View

Zheng X, Cai X, Ye F, Li Y, Wang Q, Zuo Z . Perioperative Dexmedetomidine attenuates brain ischemia reperfusion injury possibly via up-regulation of astrocyte Connexin 43. BMC Anesthesiol. 2020; 20(1):299. PMC: 7722427. DOI: 10.1186/s12871-020-01211-7. View

10.

Yu D, Zhu Y, Cui C, Long R, Ma J . Midazolam prevents sevoflurane-induced death in hippocampal neurons. Tissue Cell. 2019; 58:1-7. DOI: 10.1016/j.tice.2019.03.001. View

11.

Zhou X, Zhang C, Wang L, Jin S . Remimazolam induced cognitive dysfunction in mice via glutamate excitotoxicity. Transl Neurosci. 2022; 13(1):104-115. PMC: 9164290. DOI: 10.1515/tnsci-2022-0220. View

12.

Zhao Y, Feng X, Li B, Sha J, Wang C, Yang T . Dexmedetomidine Protects Against Lipopolysaccharide-Induced Acute Kidney Injury by Enhancing Autophagy Through Inhibition of the PI3K/AKT/mTOR Pathway. Front Pharmacol. 2020; 11:128. PMC: 7052304. DOI: 10.3389/fphar.2020.00128. View

13.

Sun Y, Zhao H, Mu D, Zhang W, Cui J, Wu L . Dexmedetomidine inhibits astrocyte pyroptosis and subsequently protects the brain in in vitro and in vivo models of sepsis. Cell Death Dis. 2019; 10(3):167. PMC: 6379430. DOI: 10.1038/s41419-019-1416-5. View

14.

Jiang S, Wu Y, Fang D, Chen Y . Hypothermic preconditioning but not ketamine reduces oxygen and glucose deprivation induced neuronal injury correlated with downregulation of COX-2 expression in mouse hippocampal slices. J Pharmacol Sci. 2018; 137(1):30-37. DOI: 10.1016/j.jphs.2018.04.001. View

15.

Li Y, Li X, Zhao J, Li L, Wang Y, Zhang Y . Midazolam Attenuates Autophagy and Apoptosis Caused by Ketamine by Decreasing Reactive Oxygen Species in the Hippocampus of Fetal Rats. Neuroscience. 2018; 388:460-471. DOI: 10.1016/j.neuroscience.2018.03.040. View

16.

Abdelmalik P, Rakocevic G . Propofol as a Risk Factor for ICU-Acquired Weakness in Septic Patients with Acute Respiratory Failure. Can J Neurol Sci. 2017; 44(3):295-303. DOI: 10.1017/cjn.2016.424. View

17.

Chen X, Chen D, Li Q, Wu S, Pan J, Liao Y . Dexmedetomidine Alleviates Hypoxia-Induced Synaptic Loss and Cognitive Impairment via Inhibition of Microglial NOX2 Activation in the Hippocampus of Neonatal Rats. Oxid Med Cell Longev. 2021; 2021:6643171. PMC: 7895593. DOI: 10.1155/2021/6643171. View

18.

Huang Y, Lu Y, Zhang L, Yan J, Jiang J, Jiang H . Perineural dexmedetomidine attenuates inflammation in rat sciatic nerve via the NF-κB pathway. Int J Mol Sci. 2014; 15(3):4049-59. PMC: 3975383. DOI: 10.3390/ijms15034049. View

19.

Rekling J . Neuroprotective effects of anticonvulsants in rat hippocampal slice cultures exposed to oxygen/glucose deprivation. Neurosci Lett. 2003; 335(3):167-70. DOI: 10.1016/s0304-3940(02)01193-x. View

20.

Zhao L, Zhai M, Yang X, Guo H, Cao Y, Wang D . Dexmedetomidine attenuates neuronal injury after spinal cord ischaemia-reperfusion injury by targeting the CNPY2-endoplasmic reticulum stress signalling. J Cell Mol Med. 2019; 23(12):8173-8183. PMC: 6850922. DOI: 10.1111/jcmm.14688. View