Anesthetics and Neurovascular Health: Molecular Pathways

Dear Colleagues,

The neurovascular interface is crucial for maintaining cerebral homeostasis. It regulates metabolic supply, vascular tone, blood–brain barrier (BBB) integrity, and neuronal function. Anesthetics, both general and regional, interact with this delicate system at various biological levels. They influence cerebral blood flow, neuroinflammation, endothelial function, and ultimately neurological outcomes. Despite the widespread clinical use of anesthetic agents, the molecular pathways underlying their effects on the neurovascular system are still not fully understood. Increasing evidence indicates that anesthetics can either provide protective effects or contribute to neurovascular dysfunction, depending on factors such as the specific pharmacological agent, the dosage, the timing of administration, and the patient's susceptibility. A better understanding of these mechanisms is vital for optimizing brain health during the perioperative period, particularly for vulnerable groups such as the elderly, pediatric patients, and individuals with cerebrovascular or neurodegenerative diseases. This Special Issue aims to compile cutting edge basic, translational, and clinical research to enhance our understanding of how anesthetics affect neurovascular biology and perioperative neurological outcomes.

We invite original research articles, reviews, systematic reviews/meta-analyses, case series, short communications, and perspectives focusing on (but not limited to) the following themes:

Molecular and Cellular Mechanisms

• Effects of anesthetic agents on neurovascular coupling, neuronal signaling, and glial activity;
• Blood–brain barrier modulation induced by anesthetics;
• Inflammatory and immunomodulatory pathways (e.g., cytokines, microglia, endothelial activation);
• Oxidative stress, mitochondrial pathways, and cellular metabolism under anesthesia.

Neurovascular Pharmacology of Anesthetics

• Mechanisms of action of volatile vs. intravenous anesthetics on cerebral vasculature;
• Regional anesthesia, autonomic modulation, and cerebrovascular physiology;
• Comparative molecular and epigenetic effects of anesthetic agents;
• Impact on cerebral autoregulation and perioperative cerebrovascular reactivity.

Clinical and Translational Implications

• Neurovascular mechanisms in perioperative neurocognitive disorders (POD/POCD);
• Anesthesia in patients with cerebrovascular disease, dementia or at-risk populations;
• The role of anesthetic choice in ischemia–reperfusion injury and stroke management;
• Neuroprotective strategies and biomarkers for perioperative brain injury.

Innovative Approaches and Future Directions

• Advanced imaging, omics, and computational modeling to study neurovascular effects;
• Biomarkers of neurovascular injury and recovery (blood, CSF, imaging, EEG);
• Novel anesthetic agents and drug-delivery technologies targeting brain–vascular pathways;
• Personalized anesthesia based on neurovascular phenotyping.

This Special Issue fills a critical scientific gap at the intersection of anesthesiology, neuroscience, and vascular biology. By integrating molecular mechanisms with clinical impact, it aims to foster new therapeutic strategies for protecting brain health throughout the perioperative journey.

Dr. Gabriele Melegari
Guest Editor

Manuscript Submission Information

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