Drugs of anesthesia, central nicotinic receptors and post-operative cognitive dysfunction.

Several drugs widely used as part of general anesthesia interact with nicotinic nAch receptors, present in the central nervous system (CNS) and involved in chemical signaling in the brain. A growing number of data have shown that compounds interacting with these receptors modulate cognitive functions. The neuromuscular blocking drugs atracurium and the atracurium and cisatracurium metabolite laudanosine, at concentrations comparable to those measured in the CNS during general anesthesia, are capable of activating nicotinic nAch receptors, whereas vecuronium does not cross the blood—brain barrier and, consequently, does not interact with these receptors. Treatment with nAch receptors agonists elicit long-lasting improving of cognitive performance in a variety of behavioral tests in animals and humans. Therefore, to administer atracurium and cisatracurium or vecuronium could be a discriminant factor in the modulation of POCD.