There is relatively little know about late effects of general anesthesia exposures, by quantity of episodes, duration of episodes. There is a debate about post operative delirium, and persisting cognitive impairments after surgery and critical illness regarding how much of the variance in outcomes may be explained by specific disease factors, generalized inflammation, and specific toxic exposure to general anesthetics and other medications.
I believe one of the reasons little Is known about gen anes is that to much is going on with the patient, his or her diseases, the peri and post-operative that gen anes gets overwhelmed in any study.
I completely agree, for small cohorts. For a very large cohort, would it be possible to look at graded effects of multiple anesthesia episodes over say 10 years, controlling for other variables, in otherwise reasonably well matched patients? If the effect size of such exposures is moderate or more, would expect a "dose" - response relationship to emerge.
Our group, APAS (Association of Participatory Anesthesia Scientists), is keenly working around General Anesthesia since 2009. The major area we are looking at are: pre-induction analgesia viz-a-viz anesthetic induction, multi-modal GA [covers the functional brain area more elaborately], depth-of-anesthesia, intraoperative implicit/explicit recall, and postoperative quality-of-life scores [PORS, OR-15, etc.]).
We firmly believe that controlling GA is the most difficult and unexplained area of anesthesia. Failings in understanding of GA is the main perpetrator and a motivating factor to make expert anesthesiologist run for extra-anesthesia technical facets that have clear mechanistic end-points, such as, Pain Medicine, Ultra-sound guided Nerve Blocks, Critical Care, and Palliative Medicine, among others.
While GA being the nerve center of anesthesia sub-specialty, its revival rest on concerted efforts by individuals/groups.
I am involved in reseach on improvements in anesthesia and ICU ventilators based on real quatotitative closed circuit. For over 35 years.
Allthough the technical progress is there, neighter phycisians or the major industries are reluctant to implement dispite the extended information like realtime metabolic monitoring, extended exact end-tidal agent management with elimination of build-in charcoal filter.
A big step was the introduction of Xenon in 1997. It showed not only a better outcome but also the organ protective properties. Outcome post event has been monitored and published. Let me know what subject(s) will be of interest and I will inform you.
My group make researches pn topical anesthesia using no opeacea nor medical products for arthrosie , some superficial hematoma, itching and the like
In ou opinion it could reduce the quantity of hard anesthsia products used during the surgerry but we have not tested yet
We have not tested sterile injection
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