ANESTHETIC NEUROPROTECTION: CURRENT EVIDENCE AND PERSPECTIVES IN THE MANAGEMENT OF NEUROLOGICAL SURGERIES
DOI:
https://doi.org/10.56238/levv16n54-114Keywords:
Anesthesia, Neuroprotection, Neurosurgery, Cerebral IschemiaAbstract
Introduction: Perioperative neurological injury remains a major concern in neurosurgical anesthesia, where ischemia–reperfusion, oxidative stress, and inflammatory cascades may lead to irreversible neuronal damage. The concept of anesthetic neuroprotection encompasses pharmacologic and physiological strategies that aim to reduce neuronal injury during neurological surgery by modulating metabolic demand, cerebral blood flow, and apoptotic signaling pathways.
Objective: The main objective of this systematic review was to evaluate current clinical and experimental evidence regarding anesthetic neuroprotection in patients undergoing neurological surgery. Secondary objectives included describing the molecular mechanisms involved, comparing the effects of different anesthetic modalities, assessing methodological quality and certainty of evidence, identifying factors contributing to heterogeneity, and proposing priorities for future research.
Methods: A systematic search was performed in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Studies published between 2015 and 2025 were included if they investigated anesthetic agents or techniques with explicit neuroprotective aims during neurological surgery. Data extraction, bias assessment (RoB 2, ROBINS-I, QUADAS-2), and certainty grading (GRADE) were conducted by two independent reviewers following PRISMA 2020 guidelines.
Results and Discussion: Seven clinical studies met the inclusion criteria. These investigations evaluated volatile anesthetic preconditioning, total intravenous anesthesia with propofol and dexmedetomidine, and non-pharmacologic adjuncts such as remote ischemic preconditioning. Most studies demonstrated reductions in biomarkers of neuronal injury (S100β, NSE, IL-6) and transient cognitive improvements but failed to show durable functional or neurocognitive benefits. The overall certainty of evidence was low due to heterogeneity, small sample sizes, and methodological limitations. Translational animal research continues to support mechanistic plausibility, but consistent clinical validation remains absent.
Conclusion: Current evidence does not support the routine use of specific anesthetic neuroprotective strategies in neurological surgery. Clinical focus should remain on maintaining cerebral perfusion, hemodynamic stability, and physiological homeostasis. Future multicenter randomized trials using standardized protocols, biomarker validation, and long-term neurocognitive endpoints are essential to clarify the real impact of anesthetic neuroprotection in neurosurgical patients.
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