General Anesthetic-Induced Neurotoxicity an Emerging Problem for the Young and Old

General anesthesia is one of the great advances of medicine and allows ever more complicated surgery to be performed safely, including on patients at the extremes of age. General anesthetics are also among the most potent centrally acting drugs in common clinical use. They produce coma and interfere with neurotransmission, largely either by positively modulating inhibitory g-amino- butyric acid (GABA) receptors or antagonizing excitatory N-methyl-D-aspartic acid (NMDA) glutamate receptors, a feature they share with known developmental neurotoxins such as ethanol and antiepileptic agents. However, general anesthesia is not without risk. This is something that we and our patients acknowledge and accept in order to enjoy its benefits. But, is central nervous system toxicity one of those risks?