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Efeitos neurotóxicos induzidos por anestésicos
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Resumo(s)
Nos últimos anos foram vários os estudos publicados que alertaram para os possíveis efeitos adversos do uso dos anestésicos gerais, estes que outrora se consideravam seguros para a prática de qualquer procedimento clínico. Os estudos levantaram a hipótese destes fármacos causarem danos cognitivos através da neuroapoptose potenciada pelo seu uso, tanto numa fase inicial da vida (em crianças) como na fase final da vida (em população mais idosa).
O objetivo desta monografia é essencialmente, através da recolha de informação e evidências científicas da relação existente entre o uso dos anestésicos gerais e a indução da neurotoxicidade.
Os resultados de estudos in vivo em suínos, ratos e primatas associam especificamente a administração de anestésicos gerais, tanto inalatórios como intravenosos, com a apoptose das células neuronais e oligodentrocitos no período gestacional e neonatal, verificando-se várias alterações a nível do neurodesenvolvimento (défices de aprendizagem, memória…). Porém, estes resultados não foram tão claros em estudos epidemiológicos retrospetivos, nomeadamente em crianças. Há estudos que mostram que possivelmente múltiplas exposições aos anestésicos podem levar a um maior risco no neurodesenvolvimento, sendo, no entanto, necessários mais estudos para poder clarificar esta relação. Por outro lado, a administração de anestésicos aos idosos parece não ter uma relação direta; ainda assim, se estes tiverem adquirido previamente uma doença neurodegenerativa tal como a doença de Alzheimer existe uma maior probabilidade de exposições múltiplas potenciarem a neuroapoptose e aceleração da doença em questão.
No entanto, a anestesia continua a ser uma ferramenta indispensável nos dias de hoje para a realização de vários procedimentos cirúrgicos da forma mais segura possível. Assim, como qualquer fármaco, os anestésicos têm efeitos benéficos e efeitos adversos; É por isso essencial o investimento em mais estudos para que as anestesias sejam administradas com segurança e com o mínimo possível de efeitos adversos ou sequelas, pois é fundamental que tanto as crianças como os idosos continuem a receber anestesias quando for realmente necessário.
In the last years there were several published studies that alarmed the scientific community concerning the use of general anesthetics that once were considered safe to use in the practice of any medical procedure. These studies point to the use of these drugs as a cause to cognitive impairment through neuroapoptose, both at an early stage of life (babies and children) as well as at the final stage of life (older people). The purpose of this monograph is essentially to collect information and scientific evidence of the relationship between the use of general anesthetics and the induction of neurotoxicity. The results observed in in vivo assays performed in pigs, rats and rhesus monkeys, associate the administration of general anesthetics, inhaled or intravenous, with apoptosis of neuronal cells and oligodendrocytes during pregnancy and neonatal period. From here, several changes in the neurodevelopment like learning deficits, memory and others, may appear. However, these results were not very clear in retrospective epidemiological studies, especially in children. It has been shown that possibly multiple exposures to anesthetics can lead to an increased risk in neurodevelopment, but we still need more investigation in order to clarify this relationship. On the other hand, the administration of anesthetics to the elderly appears to have no direct relationship unless they had previously acquired a neurodegenerative disease such as Alzheimer's disease; in this case, there is a great possibility that multiple exposures to anesthetics potentiate the neuroapoptose and acceleration of the disease. However, anesthesia continues to be a necessary tool today for performing various surgical procedures in the safest way possible. Like any drug, anesthetics have positive but also negative effects. It is therefore essential more investment in further studies in order to elucidate these mechanisms and reduce side effects, because both children and the elderly must continue to receive anesthesia whenever necessary.
In the last years there were several published studies that alarmed the scientific community concerning the use of general anesthetics that once were considered safe to use in the practice of any medical procedure. These studies point to the use of these drugs as a cause to cognitive impairment through neuroapoptose, both at an early stage of life (babies and children) as well as at the final stage of life (older people). The purpose of this monograph is essentially to collect information and scientific evidence of the relationship between the use of general anesthetics and the induction of neurotoxicity. The results observed in in vivo assays performed in pigs, rats and rhesus monkeys, associate the administration of general anesthetics, inhaled or intravenous, with apoptosis of neuronal cells and oligodendrocytes during pregnancy and neonatal period. From here, several changes in the neurodevelopment like learning deficits, memory and others, may appear. However, these results were not very clear in retrospective epidemiological studies, especially in children. It has been shown that possibly multiple exposures to anesthetics can lead to an increased risk in neurodevelopment, but we still need more investigation in order to clarify this relationship. On the other hand, the administration of anesthetics to the elderly appears to have no direct relationship unless they had previously acquired a neurodegenerative disease such as Alzheimer's disease; in this case, there is a great possibility that multiple exposures to anesthetics potentiate the neuroapoptose and acceleration of the disease. However, anesthesia continues to be a necessary tool today for performing various surgical procedures in the safest way possible. Like any drug, anesthetics have positive but also negative effects. It is therefore essential more investment in further studies in order to elucidate these mechanisms and reduce side effects, because both children and the elderly must continue to receive anesthesia whenever necessary.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2016
Palavras-chave
Anestesia geral Crianças Neurotoxicidade Défices neurocognitivos Doenças neurodegenerativas DCPO Mestrado Integrado - 2016