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Anesthetic Activation of Nociceptors: Adding Insult to Injury?

Department of Anesthesia and Perioperative Care University of California San Francisco, CA 94143

SUMMARY

General anesthetics produce a reversible loss of consciousness at low concentrations and also render patients immobile in response to surgical stimulation. Despite their widespread use for more than 150 years, the molecular mechanisms of most general anesthetics are poorly understood. Surprisingly, the sensitivity of the peripheral nociceptive neurons may be increased at clinically relevant concentrations of the same anesthetics that induce immobility. This article reviews two recent studies that propose activation of the nociceptive ion channels TRPA1 and TRPV1 as a mechanism by which certain irritant anesthetics might increase postoperative pain as well as produce airway irritation and burning pain during intravenous injection. Confirmation of the clinical relevance of this proposed mechanism through future studies might have important implications on the choice of anesthetic agents.