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Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality.

Publication ,  Journal Article
Ishida, K; Berger, M; Nadler, J; Warner, DS
Published in: Curr Pharm Des
2014

Anesthetics have been studied for nearly fifty years as potential neuroprotective compounds in both perioperative and resuscitation medicine. Although anesthetics present pharmacologic properties consistent with preservation of brain viability in the context of an ischemic insult, no anesthetic has been proven efficacious for neuroprotection in humans. After such effort, it could be concluded that anesthetics are simply not neuroprotective in humans. Moreover, pharmacologic neuroprotection with non-anesthetic drugs has also repeatedly failed to be demonstrated in human acute brain injury. Recent focus has been on rectification of promising preclinical neuroprotection data and subsequent failed clinical trials. This has led to consensus guidelines for the process of transferring purported therapeutics from bench to bedside. In this review we first examined the history of anesthetic neuroprotection research. Then, a systematic review was performed to identify major clinical trials of anesthetic neuroprotection. Both the preclinical neuroprotection portfolio cited to justify a clinical trial and the design and conduct of that clinical trial were evaluated using modern standards that include the Stroke Therapy Academic Industry Roundtable (STAIR) and Consolidated Standards of Reporting Trials (CONSORT) guidelines. In publications intended to define anesthetic neuroprotection, we found overall poor quality of both preclinical efficacy analysis portfolios and clinical trial designs and conduct. Hence, using current translational research standards, it was not possible to conclude from existing data whether anesthetics ameliorate perioperative ischemic brain injury. Incorporation of advances in translational neuroprotection research conduct may provide a basis for more definitive and potentially successful clinical trials of anesthetics as neuroprotectants.

Duke Scholars

Published In

Curr Pharm Des

DOI

EISSN

1873-4286

Publication Date

2014

Volume

20

Issue

36

Start / End Page

5751 / 5765

Location

United Arab Emirates

Related Subject Headings

  • Translational Research, Biomedical
  • Research Design
  • Neuroprotective Agents
  • Medicinal & Biomolecular Chemistry
  • Humans
  • Guidelines as Topic
  • Drug Evaluation, Preclinical
  • Clinical Trials as Topic
  • Brain Ischemia
  • Brain Injuries
 

Citation

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Ishida, K., Berger, M., Nadler, J., & Warner, D. S. (2014). Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality. Curr Pharm Des, 20(36), 5751–5765. https://doi.org/10.2174/1381612820666140204111701
Ishida, Kazuyoshi, Miles Berger, Jacob Nadler, and David S. Warner. “Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality.Curr Pharm Des 20, no. 36 (2014): 5751–65. https://doi.org/10.2174/1381612820666140204111701.
Ishida K, Berger M, Nadler J, Warner DS. Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality. Curr Pharm Des. 2014;20(36):5751–65.
Ishida, Kazuyoshi, et al. “Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality.Curr Pharm Des, vol. 20, no. 36, 2014, pp. 5751–65. Pubmed, doi:10.2174/1381612820666140204111701.
Ishida K, Berger M, Nadler J, Warner DS. Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality. Curr Pharm Des. 2014;20(36):5751–5765.

Published In

Curr Pharm Des

DOI

EISSN

1873-4286

Publication Date

2014

Volume

20

Issue

36

Start / End Page

5751 / 5765

Location

United Arab Emirates

Related Subject Headings

  • Translational Research, Biomedical
  • Research Design
  • Neuroprotective Agents
  • Medicinal & Biomolecular Chemistry
  • Humans
  • Guidelines as Topic
  • Drug Evaluation, Preclinical
  • Clinical Trials as Topic
  • Brain Ischemia
  • Brain Injuries