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General anesthetics act on several receptors in the CNS, and their effects are generally reversible. In some patient populations, though, there is an increased risk of neurotoxic side effects, including memory and cognitive impairment. This activity reviews the evaluation and management of anesthetic neurotoxicity and reviews the role of the healthcare team in improving care for patients with this condition. Objectives: Describe the pathophysiology of anesthetic neurotoxicity. Identify patient groups at increased risk of anesthetic neurotoxicity. Explain the clinical findings of anesthetic neurotoxicity. Review anesthetic drug classes associated with neurotoxicity and its management by an interprofessional team. Access free multiple choice questions on this topic.

General anesthetics are a class of medications that act on the central nervous system (CNS) to inhibit the release of excitatory neurotransmitters and enhance the release of inhibitory neurotransmitters to provide a state of unconsciousness. These medications act on several receptors in the CNS, and their effects are generally reversible.  In some patient populations, though, there is an increased risk of neurotoxic side effects, including memory and cognitive impairment. The two patient populations at the highest risk of anesthetic neurotoxicity include pediatric patients less than three years of age and elderly patients over the age of 65.

Anesthetic neurotoxicity affects patients at the extremes of age, including the pediatric and elderly populations. Risk factors must be identified by the healthcare team, including the surgeon, anesthesiologist, and nursing staff, to decrease exposure to anesthetic as much as possible. Risk factors that must be identified include age less than three or over 65, repeated anesthetic exposures, increased length of anesthetic exposure, baseline cognitive dysfunction, or dementia.[11][7] In the pediatric population, methods to decrease the incidence of anesthetic neurotoxicity include delaying elective surgery and using xenon or dexmedetomidine infusions to limit the exposure to anesthetic agents, which have been shown to cause anesthetic neurotoxicity.[12][13] In the elderly population, methods to prevent the development of postoperative cognitive disorder (POCD) and postoperative delirium (POD) include maintaining cerebral perfusion, limiting volatile anesthetic administration by using age-adjusted MAC, and intraoperative EEG monitoring.[16] Management of symptoms of POCD and POD in the elderly includes strategies to reorient the patient, including clocks, calendars, room lights, and windows.[14] [Level 3]