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Received May 14, 2017; Revised Aug 12, 2017; Accepted Aug 22, 2017
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1. Introduction
Advances in prenatal imaging and innovations in surgical techniques have resulted in a wide range of fetal interventions [1]. Because of the relatively long duration of such procedures and the necessity of general anesthesia, long-time inhalation of anesthetic such as sevoflurane is administered to help uterine quiescence and lower the premature birth risk. However, inhalation anesthetics could be powerful regulators of brain development and have been reported to contribute to detrimental behavioral deficits [2]. Several large cohort studies have investigated the neurotoxicity of anesthesia to the developing brain [3–5], but the data remain elusive. Recently, the “Drug Safety Communication” has issued a warning that general anesthesia used in pregnant women in their third trimester may affect the development of the children’s brain [6]. Sevoflurane is one of the most prevalent inhalation anesthetics in nonobstetric surgeries. Although sevoflurane has smaller potency to cause neurotoxicity to the developing brain compared with other general anesthetic such as isoflurane [7], there were still some preclinical studies reported that sevoflurane could cause neurological deficits [8, 9]. While neurogenesis abnormality is thought to play a vital role [10–12], the concrete impact of sevoflurane on fetal brain development remains poorly understood.
Most studies on the sevoflurane-induced neurotoxicity have focused on the change in the development of the hippocampus [10, 13]. It is worth noting that the third trimester is a stage at which there are high levels of neurogenesis throughout the cortex and that the development of the prefrontal cortex (PFC), a seat of the highest-order cognitive functions, plays critical roles in the onset and development of many neurodevelopmental deficits [14]. Three main types of neural progenitors, neural stem cell, radial glial cell, and intermediate progenitor cell, have been identified to be involved in the...