NEW TRENDS IN NEUROPROTECTION IN RELATION TO GENERAL ANESTHESIA

Abstract

Postoperative CNS complications are very frequent, Ranging form minor complications such as agitation, delayed recovery and postoperative pain to severe major complications e.g. during brain surgery like cerebral infarction, these complications are common to be met dug general anesthesia.

CNS complications include cerebral ischemia (focal, global), hypoxia, pneumocephalus, delayed recovery, abnormal psychological recovery, and spinal cord trauma and spinal cord ischemia.

The main cause of cerebral ischemia is cardiac arrest while other causes include cerebral embolism and hemorrhage.

So monitoring of a patient under general anesthesia is a must. Monitoring should include ordinary methods e.g. blood pressure, ECG and 02 oximetry and specific CNS monitoring e.g. EEG evoked potential and cranial neuromonitoring.

During anesthesia we must take in consideration the physiology of cerebral blood flow, cerebral perfusion and factors affecting it e.g. chemical, metabolic, and neurogenic regulation and also blood viscosity.

Various anesthetic agents including preoperative predictions, intravenous anesthetics, inhalational anesthetics and opioids have different effects on the CNS and the surgical causes are accused in these complications too.

Regimens to protect the CNS before the onset of ischemia are practical, however, it is responsible to anticipate some efficacy of certain therapies initiated after the beginning if the insult.