Anesthesia-induced neuronal apoptosis during synaptogenesis: a review of the literature

Anesthesia is generally accepted as safe in most adult populations; however, in pediatric patients questions exist regarding the potential for long-term detrimental effects. Various anesthetic agents are associated with neuronal degeneration when administered to neonatal animals. The mechanism of damage is thought to be via accelerated apoptosis, a normally beneficial process in the maintenance of homeostasis. This review of the literature examines the current evidence in neonatal rodents, nonhuman primates, and humans experiencing anesthesia-induced neuronal apoptosis. Included are studies published between the years 2000 and 2010. Much of the early research subjects were rodents, with more recent studies examining nonhuman primates. Retrospective research of human populations is included as well, some of which is currently underway. Clear evidence exists that neuronal apoptosis occurs when anesthetics are administered to neonatal rodents and primates, and behavioral and cognitive testing from some authors indicate long-term effects persist well into an animal's adulthood. Preliminary human trials reveal a link between anesthesia and subsequent developmental delays. This review of the literature clarifies the need for further research in humans.