MODERN ANESTHESIOLOGY AND SOME OF THEIR REPRESENTATIVES. THEIR EFFECT MECHANISMS

We don't know how general anesthesia works. Contrary to what was thought until relatively recently, the clinical state of anesthesia consists of several components that are mediated by the interaction of anesthetic drugs with different targets at the molecular-cellular, network, and structural-anatomical levels. Some of these drugs can have very specific molecular targets that trigger different components of "anesthesia": discrete mutations of single amino acids in certain proteins have profound effects on the ability of certain anesthetics to reach specific endpoints. does. Despite this potential specificity, inhaled anesthetics are present in the body in very high concentrations during surgical anesthesia. Due to its solubility in lipids, general anesthesia dissolves in every membrane, penetrates every organoid and can interact with a large number of cellular structures in various ways. A priori, therefore, it is not unreasonable to assume that these drugs can cause insidious changes in the body, in addition to the sharp and obvious ones that we regularly observe. Some changes may disappear shortly after withdrawal of the drug (for example, suppression of immune cell function). Others may persist and even self-reproduce after complete withdrawal of the drug, while others may be irreversible, but the significance is uncertain. This article focuses on evidence of anesthetic toxicity in the central nervous system (CNS). The CNS appears to be most sensitive to anesthetic neurotoxicity during aging, possibly through different pathways: anesthetics may induce excessive apoptosis during the peak period of synaptogenesis in neonates; In aging, CNS subtle cognitive dysfunction may persist long after drug clearance and may accelerate processes reminiscent of neurodegenerative diseases. At all ages, anesthetics affect protein synthesis that regulates gene expression in poorly understood ways. Although it seems reasonable to assume that most of our patients fully restore homeostasis after general anesthesia, it is time to recognize that the effects of these drugs are more profound and long-lasting in the brain than previously imagined[1].