Pharmacological Neuroprotection During Cardiac Surgery

Abstract

Despite more than 30 years of aggressive neuroprotective research by many investigators, neuropsychological deficit after cardiac surgery remains an important cause of postoperative morbidity. Although the neurological outcome is a result of a multifactorial etiology, many physicians world-wide have recognized the importance of this problem, and extensive efforts have been made in attempting to minimize the incidence of neurological and neurocognitive dysfunction. Pharmacological intervention is one of the important potential methods of neuroprotection during cardiac surgery. In vitro studies have identified drugs that are effective protectants against focal cerebral ischemia, hemorrhage, and global ischemia. However, at present there is no solid agreement on the need for prophylactic neuroprotectants in cardiac surgery. Researchers and clinicians must become more cognizant of the pitfalls and paradoxes that have arisen in attempting to translate the results of animal studies into clinical trial, with regard to neuroprotective therapy during cardiac surgery. There is an extensive need for new pharmacological approaches directed at reducing neurologic and neurocognitive injury during cardiac surgery. This article reviews past and present neuroprotective efforts and interventions during cardiac surgery.

Sevoflurane anesthesia did not affect postoperative cognitive dysfunction in patients undergoing coronary artery bypass graft surgery

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after cardiopulmonary bypass (CPB) has been reported in as many as 79% of patients during the early postoperative period [2][3][4][5].Several proposed techniques have been considered for neuroprotection during surgery, including the use of beta-blockers to prevent postoperative atrial fi brillation [6], increasing the level of Immunoglobulin M (IgM) anti-endotoxin core antibody [7], avoiding CPB, and strictly controlling plasma glucose levels during the perioperative period [8].Many animal studies have shown that volatile anesthetics, such as sevofl urane or isofl urane, have a preconditioning effect [9][10][11][12][13]. In addition, there have been several clinical studies regarding the effects of preadministration of volatile anesthetics, such as sevofl urane or isofl urane, on the heart during cardiac surgery.

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“…Many animal studies have shown that volatile anesthetics, such as sevofl urane or isofl urane, have a preconditioning effect [9][10][11][12][13]. In addition, there have been several clinical studies regarding the effects of preadministration of volatile anesthetics, such as sevofl urane or isofl urane, on the heart during cardiac surgery.…”

Neuromonitoring und Neuroprotektion in der Kardioanästhesie

“…Daten, die die Anwendung dieser Me dikamente im Sinne eines prophylak tischen neuroprotektiven Effektes in der Kardiochirurgie eindeutig stützen wür den, gibt es nicht [33]. Eine Studie von Nussmeier et al [46], bei der ein ver bessertes neurologisches Outcome nach Barbituratapplikation festgestellt wurde, konnte Jahre später nicht verifiziert wer den [59].…”

Cerebral Oximetry for the Prediction of Neurological Dysfunction in Cardiosurgical Patients

“…До сих пор нет полного понимания этиологии повреждения мозга при операциях на сердце, не выработан единый подход к профилактике, ранней диагностике и лечению неврологических осложнений при операциях с ИК [10,11].…”