The Effects of Anesthesia on the Brain

Tawny Stinson

Today is the day. Your heart is pounding in your chest, and you cannot pinpoint why.

There is nothing to be afraid of, right? You are in the hospital bed, clothed in the paper-like robe

and your feet burrowed in rough, itchy socks. In your arm is an IV, pumping cold, clear liquid

into your veins, sending a chill through your arm. Doctors pass by, clipboards in hand and

stethoscopes around their necks. Each time you see one, your heart skips a beat. One of them is

your doctor, and when they show up, you know it is time to go under. Finally, your doctor

appears, reading off the possible risks of the procedure, yet you are too nervous to process what

they are saying. Then, a nurse walks in, clothed in scrubs, and injects a strange needle into your

hand. Your doctor begins to count down. Five. Four. Three. Two. One. Darkness.

What I knew/What I Wanted to Learn

This is what I experienced during my first surgery. Yet after my first experience, I

became increasingly curious as to the workings of anesthesia, and thus, I began to research it.

Anesthesia has proven to be a revolutionary aspect in the medical field and is used all over the

world every day. Chances are, if you have had surgery, you have experienced either anesthetics

or sedatives, or even both. It has become such an important part of the surgical process, and it is

difficult to imagine our world without it. I have been under both anesthetics and sedatives, and

have experienced some of the minor side effects of both, piercing headaches, in particular. Prior

to my research, I knew very little about anesthetics, and I became curious as to what exactly they

are, how they work, and their effects on the body. I also have a growing interest in neurology and
aspire to pursue a career in the neurosciences, and thus I became quite curious as to how

anesthetics affect the brain. Now, why is this important? Why should you care? Well, given the

undying importance of anesthetics in the medical field, knowledge concerning their effects on

the brain could alter our perception of how we use anesthetics, and we may even be able to find

ways to reduce the amount of damage anesthetics have on the brain. To find the solution, one

must first understand the problem itself. On a local level, it is very likely that you or someone in

your community knows someone who has had surgery while under anesthetics and/or sedatives,

and thus knowledge of the possible neurological implications could also prevent such damages

from happening to your friends, family, and members of your community. Many of my friends

and family members have experienced anesthetics, and I believe that, if for nothing else, I should

research this topic, as to obtain more knowledge for when they may have to undergo surgery

again. Ever since I was a child, I have been fascinated by the complexity of the brain and how it

works, and my recent experiences with anesthesia led me to question what anesthesia is, and how

does it affect the brain and its functions? In this research paper, I will strive to understand how

and why.

My Research Process

Upon beginning my research, I was not very familiar with neither anesthetics nor the

processes and workings of anesthesia. I was aware of the general concept of anesthesia; that

anesthesia was used to alleviate pain during surgery/painful medical procedures. And I did take a

class on both chemistry and molecular biology prior to this research, which helped me better

understand the chemical workings of anesthesia. From my research, I wanted to learn how

anesthesia works, and both how and why it affects the body in the way it does. And, I especially

wanted to know how anesthetics affect the brain. However, before I explored the ways in which
anesthesia affects the brain, I needed to understand anesthesia itself; and thus, I created five sub-

questions to guide my research: What is anesthesia and how does it work? What are the general

effects of anesthesia on the body? What precautions can be taken prior to anesthesia? How does

anesthesia affect the functions of the brain? And lastly: How do anesthetics affect the structure

of the brain? To approach my research, I planned to research one sub-question a week, and

create an About-Point-React (APR) chart for each question after researching it, which I would

then post to my research blog. Thus, my total research time would be five weeks, and I could

fluctuate the time I dedicated to each question based on my schedule and the intricacy of the

question. I also created a collection of PDFs and webpages which would be helpful during my

search. Once I prepared for my research, I dove right in.

I eagerly made my way to the library, trying my best to not trip on my uncomfortably

high-heeled boots. In my hand was a purple library passwhich I get every A Day to work on

homework, projects, and/or research in the librarywhich I handed to the librarian working the

check-in table. After punching in my number and completing the brief check-in process, I was

handed a yellow card that read Computer 3 in bold lettersthat was the computer I normally

utilized for school work. I walked over to Computer 3, which was located in the lower right

corner of the main square-shaped area of the library, and plunked down my heavy bookbag. My

earbuds were already plugged into my phone as I stuck them in my ears and typed in my

username and password. The desktop popped up soon after and I immediately opened Google

where I began my search. First, I started with the regular Google search engine to grasp basic

information concerning my first sub-question: What is anesthesia and how does it work? I did,

however, make sure the sources I viewed were valid by checking the authenticity of the webpage

(.edu, and .org as opposed to .com) as well has how relevant the article is (in terms of how
recently it was published and that the author has some sort of certification). From there, I found

MedlinePlus.gov, which was possibly the most helpful webpage I came across. Medline Plus

gave an easy-to-understand summary of the basics of anesthesia as well as links to other

webpages, clinical trials, research articles, and related issues. All of the articles/studies/research

it provided links to were published by official organizations, hospitals, and/or the government,

making them direct, reliable sources. Before diving into various studies and more specific

articles, I read some of the articles that described the basics of anesthesia. In these articles, I

learned about the three types of anesthesiageneral, regional, and local anesthesiaas well as

how anesthesia is given to the patient. I also found out that there is very little information

concerning how anesthesia actually works within the body, for anesthetics are very difficult to

work with in a lab, and thus hard to study and research, especially since such research would

require human-like animal specimens (most commonly chimpanzees).

As I looked more into anesthesia, I shifted to Google Scholar in search of PDFs, research

papers, or other webpages containing more details about the process of anesthesia, and I was able

to find articles explaining the history of anesthesia (as well as how the anesthetics utilized

changed over time). As I searched, I created a Google Document where I summarized my

research. This proved to be very helpful later on, for I simply reviewed to my summary to

remember what to write in my About-Point-React charts. After about three or four non-

consecutive days of researching, I had created my own overview of anesthesia in which I

covered my first three sub-questions. I did, however, get behind schedule. I had planned to

complete one sub-question a week, however, given my joint summary of the first three questions,

I did not create my APR charts for each of those three until the conclusion of the first three
weeks. I did have my research in time, but rather than creating my APR charts immediately after

research, I did so after the research for my first three sub-questions were complete.

During the first week of my research, I contacted an anesthesiologist who works at a local

hospital. His name is Dr. Schlossberg and we were able to set up an interview time and day,

where we would meet to discuss the topic I was researching. I purposefully waited until the third

week of my researchafter I had completed my first three sub-questionsto meet with him, for

that way, I would already have a good understanding of anesthetics and the anesthesia process.

Originally, we were going to meet at either Starbucks or a similar public place, but given that he

lives very close to my house and is a good friend of my father, he offered to come over to my

house to talk. When he arrived, I printed out the research I had already completed and we sat

down at my dining room to talk. It was a Saturday, and the sun was high in the sky, illuminating

the room through its many windows so there was no need to turn on the overhead lamp. We

began reviewing my research on anesthesia in general as well as its side-effects, and then we

began discussing specific anesthetics and which ones were more commonly used. From there we

talked about the theories of how anesthesia works within the body, which led to my fourth and

fifth sub-questions, where he elaborated on many of the neurologically-related side-effects

including delirium and cognitive dysfunction. He had also brought with him two books: Clinical

Anesthesiology by G. Edward Morgan, Jr. and Maged S. Mikhail as well as Anesthesia and the

Brain by John D. Michenfelder, both of which Dr. S. was required to study during medical

school. Speaking with him not only helped me develop a strong lead for my last two sub-

questions, but also enhanced my previous research.

During the last two weeks of my research, I read through the books Dr. S. had leant to me

to dig deeper into my last two sub-questions, however, I did have a few setbacks. One issue I
was confronted with was the mass of information the books provided. Much of the information

was specific to certain anesthetics or certain types of dysfunction, so I found it difficult to

compress such a large conglomeration of research. To overcome this, I looked into the chapters

concerning the most commonly used anesthetics and sedatives as well as the most common

scenarios in which anesthetics and anesthesia cause direct repercussions to the brain. I also used

Google Scholar to look into other sources (some that were more summarized) which allowed be

to piece together the information that I believe to be the most significant. After my final two

weeks of research, I created my last two APR charts from my gathered research. The road

through my research had a few bumps and dead ends, but I was able to come through with my

research and information that answered my sub-questions as well as my overarching question:

How does anesthesia affect the brain and its functions?

What I Discovered

Anesthesia is used to nullify pain during surgery, and it does so by dissolving into the

bloodstream from inside the lungs before making its way to the brain through the blood vessels.

However, many of anesthesia's specific mechanics are unknown, for anesthetics are very difficult

to study within a lab.

Anesthesia, by definition, is insensitivity to pain, especially as artificially induced by the

administration of gases or the injection of drugs before surgical operations. It is utilized during

surgery to reduce or prevent the patients pain during the procedure. There are three types of

anesthesia: general anesthesia, regional anesthesia, and local anesthesia. During general

anesthesia, the patient is unconscious and does not feel any pain during the procedure, nor do

they remember the procedure afterwards. Regional anesthesia blocks pain in a specific part of the

body, such as a limb. One common example of regional anesthesia is epidural anesthesia, which
is used during childbirth. Local anesthesia only numbs a small part of the body; patient stays

conscious and awake during procedure, and example being gum-numbing during tooth

extractions. Sometimes, sedation is used with anesthesia. Sedation produces a sort of calming or

sleep-like feeling, almost like a trance, and can be used with or without anesthesia. The type of

anesthesia and/or sedation utilized depends on the patients health and the procedure that needs

to be done. (Anesthesia: An Introduction; Anesthesia Fact Sheet; Anesthesia: Medline

Plus).

Prior to the discovery of anesthesia, surgery was not commonly attempted, for the risks

were too high. Rather, many doctors refrained from undergoing surgery unless the condition was

life-threatening and the procedure was absolutely necessary. But even so, surgeries were usually

limited to limb amputation or removal of external growths. Alcohol, opium, and other botanical

products were used to alleviate pain, but were significantly less effective and most patients

remained conscious and experienced excruciating pain during the procedure. In 1846, a dentist

named William T. G. Morton discovered that ether, a quickly-vaporizing, colorless liquid, had

the capability to put people to sleep, and could thus be used during surgery. The practice spread

rapidly, and most doctors had their patients breath it in through an inhaler. However, at this point

in time, there was no way to control the amount of ether inhaled. If a patient inhaled too little,

they would wake up in the middle of a procedure, and if they inhaled too much, they might never

wake up. Ether is also highly flammable, thus any sparks in the medical room could be a serious

danger. Nevertheless, its discovery was revolutionary and continues to be utilized during

surgery. Over time, less-flammable gases were introduced, making the surgical room safer, and

the discovery of intravenous anesthetics agents such as sodium thiopental allowed doctors to

control how much the patient inhaled. (Anesthesia: An Introduction; History of Anesthesia).
 Many decades passed before scientists finally discovered how anesthesia worked

within the body. In the 1900s, a theory was put forth proposing that anesthetics blocked nerve

cell signaling by the means of disrupting the fatty molecules within the membranes that envelop

cells. It is difficult to study anesthetics in a laboratory, especially with the lack of tools to study

them at a molecular level, contributed to why it took scientists so long to discover how

anesthesia actually worked. Today, however, scientists no longer believed the popular theory

proposed in the 1900s. Rather, the majority of newly-acquired evidence supports the idea that the

drugs within anesthetics interfere with nerve cells by the means of targeting specific proteins

within nerve cell membranes. It is also believed that inhaled and intravenous anesthetics act upon

a different set of molecules to bring about their specific, characteristic effects. (Anesthesia Fact

Sheet). A combination of drugs, including xenon gas, sevoflurane, propofol, and midazolam are

sometimes utilized. (Clinical Anesthesia).

Upon researching this, I was quite surprised at the intricacy of anesthesia and the wide

variety of anesthetics that are utilized during the process. I also was unaware that anesthesia was

discovered in the mid-1800s; I had always anticipated it was a new concept discovered in the

mid-to-late 1900s. Another thing that shocked me was our lack of knowledge of how anesthesia

actually works. Anesthetics are very difficult to work with in a laboratory, and thus little

information concerning the specifics of its process has been discovered. That is why I enjoy

researching this topic: So little is known, so how can we discover more? And how can the

information that we dont know harm us?

The effects of anesthesia vary with the type of anesthesia, so general, regional, and local

anesthesia all have different side-effects. The most common effect, overall, is nausea, and thus

many doctors prescribe postoperative medications for their patients in order to prevent nausea,
for it can be quite painful, depending on its severity. However, that is definitely not the only

effect. There are many others, and some much more severe, including permanent nerve damage

and delirium. (Effects of Anesthesia).

Anesthesia has a variety of effects on the body itself, but these effects vary with the type

of anesthesia. Common effects of general anesthesia include: nausea and vomiting, irritated

throat, dizziness, confusion, amnesia, sore muscles/aching muscles, excessive itching (a common

side effect of narcotics) and hypothermia (chills and shivering). Rare effects of general

anesthesia include postoperative delirium, cognitive dysfunction, and malignant hypothermia.

Postoperative delirium is defined as long-lasting amnesia, confusion, or disorientation. Cognitive

dysfunction is when the brain loses multiple intellectual functions including thinking,

remembering, and reasoning. It also affects peoples ability to concentrate and impedes the

brains daily functions. Malignant hypothermia consists of a quick fever and muscle contractions

that can be life-threatening.

Common and less-severe effects of regional anesthesia on the body include headaches,

minor back pain, and difficulty urinating. More damaging effects are hematoma (bleeding

beneath the skin where the needle was injected) and pneumothorax (when anesthetics

accidentally enter the lungs from a close-range injection to the lungs, causing the lungs to

collapse and requiring a chest-tube to be inserted). The rarest effect of regional anesthesia is

nerve damage, which may result in temporary, long-term, or permanent pain. In contrast to

general and regional anesthesia, the effects of local anesthesia on the body are too small and

insignificant to have any health-implications.

I was surprised at some of the effects anesthesia, especially how common nausea was, for

I have never had nausea in my experiences under anesthesia. I was aware of the possibility of
memory loss and nerve damage, yet I did not know that malignant hypothermia was a possibility,

and frankly, I am surprised. I would not have guessed that anesthesia could result in constant

shivering and chills, and that has intrigued me to research why this is. Also, I have become more

curious as to how anesthesia results in these effects, specifically those on the brain, including

memory loss and nerve damage, since those two specifically connect to the brain.

Anesthesia, however, does have risks, and thus it is essential to prepare for the possibility

of undergoing anesthesia and/or sedation. Some patients should be especially prepared for

anesthesia, including senior citizens, children, and pregnant women. (Before Anesthesia).

As people age, their body undergoes significant changes which can also have a great

impact on how anesthesia affects their body. Older people (65 years or older) can prepare for

anesthesia by taking account of every medication (including over-the-counter medications such

as aspirin). One leading concern for older people is that their brains are more susceptible to

anesthesia, and thus they have a greater risk for postoperative delirium and postoperative

cognitive dysfunction. To ensure that the procedure is as safe as possible, seniors should ask

their doctor for a pre-cognitive test (an assessment of the brains mental condition) so that the

doctor may use that to compare to a post-cognitive test, to view how much the brain was

affected. (Anesthesia and the Brain; Anesthesia Awareness; Before Anesthesia).

Children are especially susceptible to the effects of medical procedures, given their

fragile physical state. To prepare for a procedure requiring anesthesia, the childs parents should

inform their doctor of any medications they are taking (if any) as well as any disease they may

have. Other than this, parents should try to make their children as comfortable as possible before

the procedure as to not inflict excess stress. (Anesthesia Awareness; Before Anesthesia).
 Pregnant women, during the course of their pregnancy, should keep an accurate chart of

any allergies they have, high blood pressure, prescriptions, and over-the-counter medications, for

any of these factors could influence the effects/process of anesthesia. The risk of anesthetic

complications during pregnancy and childbirth can be increased by the mothers use of drugs and

alcohol (including recreational drugs and alcohol). (Anesthesia Awareness; Before

Anesthesia).

Even though these three types of patients are more susceptible to anesthesia, it is

important for all patients undergoing anesthesia to prepare. If a patient has a genetically inherited

disease (such as sickle-cell anemia), they should inform their doctor, so that precautions and

special attention may be provided to make the procedure as safe as possible. All patients should

inform their doctors of their medical history and ask questions about any concerns they may

have. It is important for patients to inform their doctor if they are/could be pregnant, any

medications they take (prescription and over-the-counter), any allergies, and whether or not they

do drugs, drink alcohol, and/or smoke. Any unnecessary alcohol-consumption, smoking, and

drug use should cease days before the procedure. (Anesthesia Awareness; Before

Anesthesia).

On the day of the procedure, most patients are required by their doctor to stop eating

and drinking (anything except water) the night before. This will thus prevent any vomiting or

nausea while under anesthesia, for the chemicals within anesthetics can irritate the stomach and

digestive process. Sometimes, the night before the procedure, patients may be required to wash

themselves with a prescribed antibacterial soap. It is also common for doctors to prescribe

medications that patients must take before the procedure. (Anesthesia Awareness; Before

Anesthesia; Role of the Anesthesiologist).

 As for after the procedure, patients should take any medications provided to them by

their doctor, as well as rest. Many patients will experience dizziness and nausea, but medications

for these can be provided by their doctor. Rest and recovery, however, is essential.

When it comes to neurological implications, anesthetics affect the brains functions in

many different ways; far too many to summarize. So, in this research, I have looked into the

major effects anesthetics can have on the brain, from specific anesthetics such as sevoflurane,

propofol, and ketamine as well as the overall effects of anesthetics on the brain. Given that it is

very difficult to work with anesthetics in a lab, little information has been discovered and

published on the exact ways it influences the brain, so I have looked into the major papers and

studies focusing on the riskiest threats.

Different anesthetics can have different effects on the brain. Sevoflurane, for example, in

low doses can still affect the brains ability to maintain memory. Also, researchers have

discovered that increased blood flow to the brain impact the way the brain cells reproduced and

preformed their usual functions, thus slowing the entire neurological process down.

Sevoflurane, a commonly used anesthetic, can (even in small does) damage the medial

temporal lobe of the brain and thus the limbic system, which deals with memory. It can also

damage the primary visual cortex as well as its association cortex, both of which deal with the

brains ability to process images as well as retain them in its memory. Thus, if one or all of these

structures were to be damaged, the brain would be unable to retain image memory or memory in

general, hence the occurrence of cognitive dysfunction in patients. Similarly, people who abuse

the use of alcohol and drugs may also experience cognitive dysfunction, for continued alcohol

and drug use can also have these effects on the brains structure. (Anesthesia: An Introduction;

Anesthesia and the Brain; Clinical Anesthesiology; How Anesthesia Affects the Brain;
What Happens to Your Brain Under Anesthesia; What Happens to Your Brain When You Go

Under Anesthesia).

Propofol (which is the most commonly used anesthetic, given its simplicity, convenience

and safety) binds receptors within the brain by beginning in the center of the brain and then

spreading outwards to the brains different regions. It can also have long-term structural effects

on the brain. Although uncommon, propofol can cause damage to the brains frontal lobe, which

focuses on problem solving, motor function, language, impulse, memory, and many other

neuropsychological functions. It is also possible for propofol, if misused or given in too high of a

dosage, to damage the temporal lobe, which mainly focuses on auditory perception/hearing.

(Anesthesia: An Introduction; Anesthesia and the Brain; Clinical Anesthesiology; How

Anesthesia Affects the Brain; What Happens to Your Brain Under Anesthesia What

Happens to Your Brain When You Go Under Anesthesia).

Ketamine (which is commonly used side-by-side with propofol) inhibits the patients

senses, judgement, and coordination for as long as twenty-four hours. To do this, it must inhibit

the brains chemical system and alter neurotransmitter functions, which may destabilize the

brains chemical balance. If ketamine is continuously supplied to the body, then it may harm

nervous functions. It can also destabilize the brains chemical balance, for it must disrupt the

chemical system in order to implicate its relaxing, sedated effect. A long-term, continuous supply

of ketamine to the body could deteriorate/damage parts of the nervous system, which could result

in temporary, long-term, or permanent nerve damage. (Anesthesia: An Introduction;

Anesthesia and the Brain; Clinical Anesthesiology; How Anesthesia Affects the Brain;

What Happens to Your Brain Under Anesthesia What Happens to Your Brain When You Go

Under Anesthesia).
 When anesthetics are utilized, they decrease the amount of oxygen, as well as the

substrate consumption, of brain tissue. They lead to a depression in the metabolic rate, however,

they do not affect the energy state of the brains tissue. Despite this, anesthetics have a

significant influence on tissue function (just not their state of energy). Effects that occur to the

metabolic rate occur secondly; they are secondary effects, whereas the influences on tissue

structure are the primary effects. Some of the less common long-term effects discovered in this

study include marked as well as enhanced metabolic rates which were associated with either

cortical or subcortical electroencephalographic (electroencephalography is a monitoring method

used to monitor the brains electrical activity) seizures. (Anesthesia and the Brain)

Studies have been undergone that test how anesthetics affect the brain of juvenile animals

(particularly mice and monkeys) as to attempt to discover how the brain functions of younger

children are affected by anesthetics. The cases showed both short term and long term effects.

Many of the long-term effects included neurodevelopment impairment. This study shed light

upon the possible long-term dangers of anesthetics on the adolescent brain. (Anesthesia and the

Brain; Clinical Anesthesia;

I was quite surprised at the many different was anesthetics influence the brains

functions. I did not expect such a wide variety of effects; I had predicted to find a few, but the

ones I did find surprised me. I already knew that anesthetics affected memory, yet I was shocked

to find that they also affect chemical balances in the brain as well as the fact that propofol can

actually slow down the brains functions. Overall, I have to say that I am pleased with the

information I have uncovered and was quite surprised with what I found.

Long-term neurological dysfunctions after anesthesia result from structural damage in the

brain that occurred. In this section of my research, I will be looking into the common anesthetics
and what structural impacts they have been found to have on the brain. This includes ketamines

impact on chemical imbalance as well as sevofluranes impact the limbic (memory) system as

spoken about earlier.

There have been some tests that focus on how anesthetics affect the brain structure of

young animals (rats and monkeys), and the studies have shown that a growing number of cases

resulted in neurodegeneration within the young animals, which proves that such an occurrence

may also result in adolescent human children. Many of the animal testers showed decline in the

neurological structure and some showed long-term structure damage. (Anesthesia and the

Brain; What Happens to Your Brain When You Go Under Anesthesia).

Prior to my research, I was unaware of the rather significant effects anesthetics can have

on the brains structure, especially misused. While researching this, I found myself connecting

this to my knowledge of the effects different drugs have on the brain, for they cause similar

structural damage and thus similar functional dysfunction. This has intrigued me to look into

some of the lesser-studied anesthetics, to see if they have similar structural impacts and if there is

any way to reduce these damages.

Conclusion

Throughout my research, I discovered that anesthesia affects the brain in multiple

different ways, however, these effects vary with the patients health condition as well as the

anesthetics utilized. Both long-term and short-term effects may result, yet long-term effects are

very rare and most neurological short-term effects are relatively uncommon. To answer my

overarching question, anesthetics can affect the brain by damaging memory-centered areas of the

brain, including the frontal lobe, resulting in memory loss/loss of the ability to maintain
memories. I also found that not much is known about the effects of anesthesia on the bodys

structure, which I found surprising, since I was not aware of how difficult anesthetics are to

study.

Overall, I thought that the research process was helpful in allowing me to get used to the

research process. It also taught me to manage my time and how to effectively research, as well as

how to search for reliable sources. This research has also allowed me to experience reaching out

to a professional, which I will need to utilize as I proceed to find an internship for my senior

project.

This research has definitely inspired me to research deeper within it as well as look into

related topics. My interest in anesthesia has heightened, and I would love to research more into

specific anesthetics as well as anesthesiology as a whole. I am also curious as to how specifically

(as well as why) anesthetics damage nerve cells, if such research has been conducted. This

research has also increased my love for neurology, which I still wish to pursue as my career. I am

intrigued to research how more types of drugs/medications affect the brain as well as more

psychological-reactions of the brain to other stimuli.

I believe that this was an amazing opportunity for me to gain experience conducting

reliable, relevant research as well as studying a topic that I find to be exciting and interesting.

Not only has it helped me improve my research, but it has also provided me with the basis for

which I wish to conduct my senior project, for I hope to study some sort of neurology for my

senior project. Going into this research, I was a little skeptical, but now, I am excited to continue

this research further.

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