Effects of propofol on the developing brain

Abstract

Background Propofol is commonly used in pediatric surgery, while its detrimental effects on neurobehavior in children subjected to surgery are recognized in the field, and attract more and more attention from scientists. Objective To describe the adverse effects of propofol on the developing brain, and to summarize potential interventional and therapeutic strategies to prevent or reverse neurobehavioral dysfunctions following propofol anesthesia. Content Propofol confers its anesthetic efficacy by regulating gamma amino acid(GABA) and N-methyl-D-aspartate (NMDA) receptors. Because of the unique characteristics of neurons and neural circuit connections in the developing brain, propofol exceptionally interferes brain functions at both cellular and circuit levels. Propofol has been demonstrated to disrupt calcium homeostasis, elevating intracellular calcium concentrations, and to inhibit the synthesis of mature neurotrophic factors. These cellular events may contribute to propofol-induced cellular and circuit outcomes, such as, neuronal apoptosis, imbalance of excitatory and inhibitory drives to neurons, loss of synaptic plasticity, and enhancement of inflammatory reaction. Accumulating experimental evidence shows that 17--estradiol, dexmedetomidine, acetyl-L-carnitine, erythropoietin, and lithium salts have therapeutic potentials to propofol-induced dysfunctions on developing brain. Trend Most toxicological and therapeutic experiments were conducted in animals. More sophisticated mechanistic experiments and clinical trials are warranted to advance our understanding of neuro-pathophysiological bases of propofol, and to provide new avenue for interventional and therapeutic strategies to treat Propofol-induced neural dysfunctions. Key words: Propofol; Developing brain