Influence of central neuraxial blockade on anesthetic pharmacology and brain function

Abstract

Central neuraxial blockade (CNB) is a well-known and relative easy way to perform surgery

without pain and it can be used to achieve good postoperative analgesia. The two most

frequently used techniques, spinal and epidural anesthesia, are the main subject of this thesis.

Both spinal and epidural anesthesia are worldwide applied in tens of thousands patients on a daily basis and consequently in millions each year. Still many effects of especially the deafferentation caused by neuraxial blockade is poorly studied and poorly understood. Neuraxial blockade results in disruption of ascending and descending input to the brain, i.e., deafferentation, and has an impact on a range of factors such as the pharmacology of anesthetics (e.g., propofol) and the balance between the excitatory and inhibitory modulation of afferent stimuli. These effects will cause changes in pharmacokinetics and pharmacodynamics of general anesthetics, pain perception and connectivity in functional brain networks. This thesis describes a subset of topics related to temporary deafferentation in patients and healthy volunteers. The aim of the studies is understanding the effect of neuraxial blockade and the subsequent short-term deafferentation on the development of propofol anesthesia and pain perception.