Neuronal Cell Death Modalities and Protective Mechanisms Induced By Sevoflurane: A Narrative Review.

Area of Science:

• Neuroscience
• Anesthesiology
• Toxicology

Background:

• Sevoflurane is a common inhaled anesthetic used in surgeries for adults and children.
• Neurotoxic long-term effects, such as cognitive impairment, have been associated with sevoflurane exposure in both pediatric and adult populations.
• Neuronal cell death is a key mechanism underlying sevoflurane-induced neurotoxicity.

Purpose of the Study:

• To review and analyze existing animal and clinical data on the neurotoxic potential of sevoflurane.
• To investigate the effects of sevoflurane on the developing and aged brain.
• To highlight cell death modalities and propose strategies to mitigate neurotoxicity.

Main Methods:

• Comprehensive review of published animal and clinical studies.
• Analysis of data investigating sevoflurane's impact on neuronal cell death.
• Examination of mechanisms including apoptosis, ferroptosis, necroptosis, pyroptosis, mitochondrial dysfunction, and oxidative stress.

Main Results:

• Sevoflurane exposure is linked to various forms of neuronal cell death.
• Mitochondrial dysfunction and oxidative stress are implicated in sevoflurane-mediated neurotoxicity.
• The review identifies specific cell death pathways involved in neurological function alteration.

Conclusions:

• Distinct cell death modalities play a critical role in sevoflurane-induced neurotoxicity, particularly in vulnerable populations.
• Understanding these mechanisms is crucial for developing strategies to minimize adverse neurological outcomes.
• Further research is needed to refine protective interventions against sevoflurane neurotoxicity.