The cerebral protective effect of anaesthetics

The concept of cerebral protection refers to any prophylactic measure initiated before an ischaemic insult to improve the tolerance of the central nervous system to that insult. Theoretical strategies for protecting the brain proceed from pathophysiology and rely on both the metabolic and biochemical theories. Decreasing cerebral metabolism and, more importantly, preventing the cascade of biochemical events consecutive to cerebral ischaemia are central to this process. This article will consider the potential neuroprotective effect of anaesthetic agents. The tolerance to ischaemia appears to be better during anaesthesia than during the awake state. According to basic studies and experimental data, most of the anaesthetic agents share interesting properties consistent with the potential mechanisms of cerebral protection. However, experimental success does not automatically result in clinical benefit. Although cerebral protection seems to depend more on specific drugs and techniques, it cannot be concluded that anaesthetic agents play a substantial role as first choice adjuvants. Answering that question and defining the modalities of a neuroprotective anaesthetic is an exciting challenge for the future.